Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 5467A | WY |
NPI | 1003801051 |
---|---|
Provider Name | Gerard P Cournoyer |
First Address | Rock Springs, WY 82901-5857 |
Second Address | Rock Springs, WY 82901-5857 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2005 |
Last Update Date | 18/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
306857 | BCBS OF WYO (01) | WY |
F99769 | (02) |