Individual
ROLAND FLECK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
555 E BROADWAY, SUITE 212, JACKSON, WY 83001
(307) 733-7677
(307) 733-7679
Mailing address
PO BOX 1766, 555 E BROADWAY SUITE 212, JACKSON, WY 83001
(307) 733-7677
(307) 733-7679
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
2822A
WY
208600000X
Surgery Physician
7844
MT
208600000X
Surgery Physician
M4186
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
301378
BCBS
WY
01
—
37747
BC OF IDA
ID
Enumeration date
09/12/2006
Last updated
07/08/2007
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