Individual
MARK D PRINCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
921 S BALLANCEE AVE, LUSK, WY 82225
(307) 334-4000
Mailing address
PO BOX 780, LUSK, WY 82225-0780
(307) 334-4000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2848A
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00356
WINHEALTH PARTNERS
WY
01
—
110187400
RAILROAD MEDICARE
WY
05
—
114388300
—
WY
01
—
308045
BLUE SHIELD
WY
01
—
82009A032
WPS TRIWEST
WY
Enumeration date
07/25/2006
Last updated
04/07/2021
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