Provider Demographics
NPI:1679851570
Name:ROCKY MOUNTAIN PM&R LLC
Entity Type:Organization
Organization Name:ROCKY MOUNTAIN PM&R LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:L
Authorized Official - Last Name:BUCKNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-333-6567
Mailing Address - Street 1:PO BOX 2170
Mailing Address - Street 2:
Mailing Address - City:MILLS
Mailing Address - State:WY
Mailing Address - Zip Code:82644-2170
Mailing Address - Country:US
Mailing Address - Phone:307-333-1620
Mailing Address - Fax:307-242-5615
Practice Address - Street 1:5880 ENTERPRISE STE 400
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609-4295
Practice Address - Country:US
Practice Address - Phone:307-333-6567
Practice Address - Fax:307-265-2860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-26
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty