Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 170100000X | Medical Geneticist | 7192A | WY |
Y | 207L00000X | Anesthesiologist | 7192A | WY |
NPI | 1376658104 |
---|---|
Provider Name | Matthew D Chynoweth |
First Address | Casper, WY 82604-5201 |
Second Address | Casper, WY 82604-5201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2006 |
Last Update Date | 19/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
121629500 | (05) | WY |