Provider Demographics
NPI:1003490145
Name:FLANDERS, JEREMY ALAN
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:ALAN
Last Name:FLANDERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 272
Mailing Address - Street 2:
Mailing Address - City:STORY
Mailing Address - State:WY
Mailing Address - Zip Code:82842-0272
Mailing Address - Country:US
Mailing Address - Phone:307-620-2556
Mailing Address - Fax:
Practice Address - Street 1:2115 E SHERIDAN ST
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82070-4332
Practice Address - Country:US
Practice Address - Phone:307-620-2556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-05
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management