Individual
JOHN R VIPPERMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
3030 BIG HORN AVE, CODY, WY 82414-9208
(307) 578-1955
(307) 578-1979
Mailing address
3030 BIG HORN AVE, CODY, WY 82414-9208
(307) 578-1955
(307) 578-1979
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
207
WY
363AM0700X
Medical Physician Assistant
306
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000094353
BLUE CROSS BUTTE MT
MT
05
—
0439535
—
MT
05
—
117477100
—
WY
01
—
3110550
BLUE CROSS
WY
01
—
810511516021
EBMS
MT
Enumeration date
11/16/2005
Last updated
01/30/2020
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