Provider Demographics
NPI:1003801051
Name:COURNOYER, GERARD P (MD)
Entity Type:Individual
Prefix:
First Name:GERARD
Middle Name:P
Last Name:COURNOYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1208 HILLTOP DR
Mailing Address - Street 2:STE 102
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82901-5857
Mailing Address - Country:US
Mailing Address - Phone:307-382-9101
Mailing Address - Fax:307-382-9220
Practice Address - Street 1:1208 HILLTOP DR
Practice Address - Street 2:STE 102
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-5857
Practice Address - Country:US
Practice Address - Phone:307-382-9101
Practice Address - Fax:307-382-9220
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-15
Last Update Date:2007-12-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WY5467A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY306857OtherBCBS OF WYO
WY9896Medicare PIN
WY306857OtherBCBS OF WYO