Organization
OREGON TRAIL EMERGENCY PHYSICIANS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROSS RONAN (VICE PRESIDENT)
(469) 401-2386
Entity
Organization
Contact information
Practice address
6550 E 2ND ST, CASPER, WY 82609-4321
(469) 401-2386
Mailing address
13737 NOEL RD, STE 1600, DALLAS, TX 75240-1331
(469) 401-2386
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06310001
WY BLUE CROSS/SHIELD
WY
05
—
1518125384
—
WY
01
—
DN9299
MEDICARE RAILROAD
WY
Enumeration date
05/29/2008
Last updated
07/22/2015
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