Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 5629A | WY |
N | 207V00000X | Obstetrician & Gynecologist | 5629A | WY |
NPI | 1023031861 |
---|---|
Provider Name | Dr. Marvin Wayne Couch II |
First Address | Laramie, WY 82070-3839 |
Second Address | Rawlins, WY 82301-5241 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2006 |
Last Update Date | 28/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G23176 | (02) | WY |