Organization
FRONTIER SPINE AND ORTHOPEDIC SURGERY, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JUSTIN MORONI DAZLEY M.D. (ORGANIZER)
(801) 916-0829
Entity
Organization
Contact information
Practice address
4401 COLLEGE DR, ROCK SPRINGS, WY 82901-3507
(307) 352-8930
(307) 352-8947
Mailing address
4117 N. 2600 E, FILER, ID 83328
(801) 916-0829
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
TL4296
WY
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
TL4296
WY
Other
Enumeration date
08/14/2018
Last updated
08/14/2018
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