Organization
EVANSTON FAMILY FOOT CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JASON CANNON LEVITRE DPM (PODIATRIST)
(307) 789-8997
Entity
Organization
Contact information
Practice address
1565 HIGHWAY 150 SOUTH, SUITE C, EVANSTON, WY 82930-5348
(307) 789-8997
(307) 789-2624
Mailing address
PO BOX 238, EVANSTON, WY 82931-0238
(307) 789-8997
(307) 789-2624
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
127
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1217844 00
—
WY
01
—
DD8254
RAILROAD MEDICARE
WY
Enumeration date
12/24/2007
Last updated
01/06/2008
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