Grand Ave Family Medicine

NPI #1437842390 in Laramie, Wyoming

Provider Information

NPI Number: 1437842390
Entity Type: Organization
Organization Name: Grand Ave Family Medicine
Primary Specialty: Family Medicine
Enumeration Date: May 29, 2023
Last Updated: May 29, 2023

Practice Location

Address: 3236 E GRAND AVE STE D
City: Laramie
State: Wyoming
ZIP Code: 82070-5100
Phone: (970) 231-3498

Authorized Official

Name: JOHN JACOBS III, NP
Title: OWNER
Phone: (970) 231-3498

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Family Medicine	207Q00000X	Primary

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