Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 2824A | WY |
NPI | 1336177120 |
---|---|
Provider Name | Dr. Richard M. Jaouen |
First Address | Casper, WY 82601-2903 |
Second Address | Casper, WY 82601-2903 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2006 |
Last Update Date | 03/11/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
119886600 | (05) | WY |
314782 | BLUE CROSS BLUE SHIELD (01) | WY |
D24632 | (02) | WY |
P00403110 | RAILROAD MEDICARE (01) | WY |