Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PE0004X | Emergency Medical Services | 5661A | WY |
Y | 207Q00000X | Family Doctor | 5661A | WY |
NPI | 1134117039 |
---|---|
Provider Name | Brian Dale Gee |
First Address | Lander, WY 82520-3431 |
Second Address | Lander, WY 82520-3431 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2005 |
Last Update Date | 30/09/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110987100 | (05) | WY |
G47726 | (02) | WY |