Western Divide Anesthesia, PC

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

10772A Issued in WY

Legal business name

WESTERN DIVIDE ANESTHESIA, PC

Practice address

1524 W 5TH St
Sheridan, WY 82801-2707

Phone

(307) 672-7874

NPI assigned

Oct 2, 2017

Last updated

Nov 1, 2017By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jeffrey F Pal, MD

Title

Owner

Phone

(970) 846-2852

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1506902400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1509494400000",
    "number": "1073023214",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3610",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834033610",
            "telephone_number": "208-525-2090",
            "fax_number": "208-523-8978"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1524 W 5TH ST",
            "city": "SHERIDAN",
            "state": "WY",
            "postal_code": "828012707",
            "telephone_number": "307-672-7874"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESTERN DIVIDE ANESTHESIA, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-02",
        "last_updated": "2017-11-01",
        "status": "A",
        "authorized_official_last_name": "PAL",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "970-846-2852",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "WY",
            "license": "10772A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Anesthesiology Physician in Sheridan, WY
• Providers in Sheridan, WY by specialty
• Anesthesiology Physician in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.