Provider Demographics
NPI:1225203011
Name:TOM POCKAT MD PC
Entity Type:Organization
Organization Name:TOM POCKAT MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:POCKAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-733-6520
Mailing Address - Street 1:PO BOX 4182
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83001-4182
Mailing Address - Country:US
Mailing Address - Phone:307-733-6520
Mailing Address - Fax:307-733-3216
Practice Address - Street 1:555 E. BROADWAY ST.
Practice Address - Street 2:SUITE 202
Practice Address - City:JACKSON
Practice Address - State:WY
Practice Address - Zip Code:83001-4182
Practice Address - Country:US
Practice Address - Phone:307-733-6520
Practice Address - Fax:307-733-3216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-23
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY3222A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty