1265596084 NPI number — DR. JOHN RICHARD MCPHERSON DDS

Table of content: DR. JOHN RICHARD MCPHERSON DDS (NPI 1265596084)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265596084 NPI number — DR. JOHN RICHARD MCPHERSON DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCPHERSON
Provider First Name:
JOHN
Provider Middle Name:
RICHARD
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265596084
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1408 MITCHELL ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LARAMIE
Provider Business Mailing Address State Name:
WY
Provider Business Mailing Address Postal Code:
82072-2271
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
307-745-8170
Provider Business Mailing Address Fax Number:
307-742-0543

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
204 MCCOLLUM ST
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
LARAMIE
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82070-5103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-742-2328
Provider Business Practice Location Address Fax Number:
307-742-0543
Provider Enumeration Date:
12/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  WY 1100 , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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