Organization
COWBOY CAPITAL EMERGENCY PHYSICIANS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM C JERNBERG (PRESIDENT)
(214) 712-2000
Entity
Organization
Contact information
Practice address
411 N BELKNAP ST, STEPHENVILLE, TX 76401-3415
(254) 965-1500
Mailing address
PO BOX 13560, PHILADELPHIA, PA 19101-3560
(214) 712-2000
(214) 712-2487
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0086MW
BLUE SHIELD
TX
Enumeration date
05/18/2006
Last updated
04/20/2008
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