Organization
MOUNTAIN TRAIL MEDICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARVIN WAYNE COUCH II MD (PRESIDENT/OWNER)
(307) 320-7075
Entity
Organization
Contact information
Practice address
542 16TH ST, RAWLINS, WY 82301-5241
(307) 324-2759
Mailing address
1001A E HARMONY RD # 338, FORT COLLINS, CO 80525-3354
(307) 314-3330
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
01/21/2019
Last updated
11/29/2023
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