Individual
DONALD B TARDIF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
501 S BURMA AVE, GILLETTE, WY 82716-3426
(307) 464-0413
(307) 688-7965
Mailing address
PO BOX 3011, GILLETTE, WY 82717-3011
(307) 464-0413
(307) 688-7965
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
246
WY
363AM0700X
Medical Physician Assistant
246
WY
363AS0400X
Surgical Physician Assistant
246
WY
Other
Enumeration date
09/28/2006
Last updated
10/14/2020
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