Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 10960A | WY |
N | 207X00000X | Orthopaedic Surgeon | L9715 | TX |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | L9715 | TX |
NPI | 1720019060 |
---|---|
Provider Name | Timothy C. Gueramy |
First Address | Laramie, WY 82070-5530 |
Second Address | Laramie, WY 82070-5599 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 25/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
094771502 | (05) | TX |
184372402 | (05) | TX |
7475736 | AETNA TRS (01) | TX |
85263 | SCOTT & WHITE (01) | TX |
8R0760 | BCBS (01) | TX |
H49087 | (02) | TX |