Individual
DANIEL W. FEDORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
4140 CENTENNIAL HILLS BLVD, STE A, CASPER, WY 82609
(307) 265-7205
(307) 235-6262
Mailing address
4140 CENTENNIAL HILLS BLVD, STE A, CASPER, WY 82609-3265
(307) 265-7205
(307) 235-6262
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
247
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
117270100
—
WY
01
—
312443
BCBS
WY
01
—
P00059533
RR MEDICARE
WY
Enumeration date
08/23/2005
Last updated
06/11/2018
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