Provider Demographics
NPI:1043615388
Name:HOBART, EDWARD DANIEL JR (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:DANIEL
Last Name:HOBART
Suffix:JR
Gender:M
Credentials:MD
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 625
Mailing Address - Street 2:
Mailing Address - City:BIG HORN
Mailing Address - State:WY
Mailing Address - Zip Code:82833-0625
Mailing Address - Country:US
Mailing Address - Phone:307-234-2632
Mailing Address - Fax:
Practice Address - Street 1:80 BLACKTOOTH ROAD
Practice Address - Street 2:
Practice Address - City:BIG HORN
Practice Address - State:WY
Practice Address - Zip Code:82833-0625
Practice Address - Country:US
Practice Address - Phone:307-234-2632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-29
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY5206A207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYNO NUMBEROtherNO NUMBER AVAILABLE