Organization
GRAND AVE FAMILY MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN JACOBS III NP (OWNER)
(970) 231-3498
Entity
Organization
Contact information
Practice address
3236 E GRAND AVE STE D, LARAMIE, WY 82070-5100
(970) 231-3498
Mailing address
3236 E GRAND AVE STE D, LARAMIE, WY 82070-5100
(970) 231-3498
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
05/29/2023
Last updated
05/29/2023
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