Individual
TED J AJAX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
732 LINDSAY LN, CODY, WY 82414-4103
(307) 587-2139
Mailing address
PO BOX 3451, IDAHO FALLS, ID 83403-3451
(208) 525-2090
(208) 252-2662
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
6488A
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
115651900
—
WY
Enumeration date
05/16/2006
Last updated
08/08/2012
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