Dr. Clyde Wallace Stock
Oral & Maxillofacial Surgeon
156 County Road 114
Freedom
, Wyoming 83120
Dr. Clyde Wallace Stock
Oral & Maxillofacial Surgeon
156 County Road 114
Freedom
, Wyoming 83120
(307) 880-2760
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About
Features
Specialties
- Oral & Maxillofacial Surgeon
Languages spoken
- English
Location
First Address
- Dr. Clyde Wallace Stock
- Po Box 227
- Freedom, WY
- Zip : 83120
- Phone : (307) 880-2760
Second Address
- Dr. Clyde Wallace Stock
- 156 County Road 114
- Freedom, WY
- Zip : 83120
- Phone : (307) 880-2760
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 204E00000X | Oral & Maxillofacial Surgeon | 472 | WY |
National Provider Identifier
| NPI | 1144568924 |
|---|---|
| Provider Name | Dr. Clyde Wallace Stock |
| First Address | Freedom, WY 83120 |
| Second Address | Freedom, WY 83120 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 29/01/2013 |
| Last Update Date | 29/01/2013 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.