Organization
FREMONT COUNTY PEDIATRIC CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD E. BARNES M.D. (OWNER)
(307) 332-2185
Entity
Organization
Contact information
Practice address
115 WYOMING ST, LANDER, WY 82520-3919
(307) 332-2185
(307) 332-7799
Mailing address
115 WYOMING ST, LANDER, WY 82520-3919
(307) 332-2185
(307) 332-7799
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
5774A
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
111666500
—
WY
01
—
W308732
MEDICARE PTAN
WY
Enumeration date
09/26/2006
Last updated
04/25/2013
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