Provider Demographics
NPI:1114452166
Name:PAULJORDANWASHBURNMD, LLC.
Entity Type:Organization
Organization Name:PAULJORDANWASHBURNMD, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWN, PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:JORDAN
Authorized Official - Last Name:WASHBURN
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH
Authorized Official - Phone:970-518-9394
Mailing Address - Street 1:5720 OSAGE AVE
Mailing Address - Street 2:3-301
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-3948
Mailing Address - Country:US
Mailing Address - Phone:970-518-9394
Mailing Address - Fax:
Practice Address - Street 1:5720 OSAGE AVE
Practice Address - Street 2:3-301
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-3948
Practice Address - Country:US
Practice Address - Phone:970-518-9394
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-27
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY10738A261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty