Individual
AHMAD BASHIRIMOGHADDAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1200 COLLEGE DR, ROCK SPRINGS, WY 82901-5868
(307) 352-8320
(307) 352-5345
Mailing address
1200 COLLEGE DR, ROCK SPRINGS, WY 82901-5868
(307) 352-8320
(307) 352-5345
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
14727A
WY
207R00000X
Internal Medicine Physician
TL7240
WY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/15/2018
Last updated
08/30/2022
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