Organization
FRONTIER SPINE AND ORTHOPEDIC SURGERY, P.C.
Active
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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