Provider Demographics
NPI:1003050253
Name:BIG HORN FOOT CLINIC, PC
Entity Type:Organization
Organization Name:BIG HORN FOOT CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DUNCAN
Authorized Official - Middle Name:HUGH
Authorized Official - Last Name:FRASER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:307-527-9191
Mailing Address - Street 1:777 AVENUE H
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:WY
Mailing Address - Zip Code:82435-2260
Mailing Address - Country:US
Mailing Address - Phone:307-754-9191
Mailing Address - Fax:
Practice Address - Street 1:424 YELLOWSTONE AVE
Practice Address - Street 2:SUITE 140
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-9318
Practice Address - Country:US
Practice Address - Phone:307-527-9191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-30
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY104213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY1245365154OtherDMERC NPI FOR 777 AVENUE H POWELL, WY 82435
WY113976200Medicaid
WY1114923463OtherNPI FOR D HUGH FRASER DPM
WY307844OtherBLUE CROSS BLUE SHIELD
WY480027493OtherRAILROAD MEDICARE
WY307844OtherBLUE CROSS BLUE SHIELD
WY113976200Medicaid