Southwest Wyoming Ent INC

NPI #1730335423 in Evanston, Wyoming

Provider Information

NPI Number: 1730335423
Entity Type: Organization
Organization Name: Southwest Wyoming Ent INC
Primary Specialty: Otolaryngology
Enumeration Date: Aug 13, 2008
Last Updated: Oct 24, 2013

Practice Location

Address: 191 OVERTHRUST RD
City: Evanston
State: Wyoming
ZIP Code: 82930-9261
Phone: (307) 789-8721

Authorized Official

Name: JASON P HAACK, MD
Title: OWNER
Phone: (307) 789-8721

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Otolaryngology - Facial Plastic Surgery — Facial Plastic Surgery	207YS0123X
Otolaryngology	207Y00000X	Primary

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