Provider Demographics
NPI:1790764520
Name:ARGERIS, BRETT J (PAC)
Entity Type:Individual
Prefix:MR
First Name:BRETT
Middle Name:J
Last Name:ARGERIS
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 SOUTH 15TH STREET
Mailing Address - Street 2:
Mailing Address - City:WORLAND
Mailing Address - State:WY
Mailing Address - Zip Code:82401
Mailing Address - Country:US
Mailing Address - Phone:307-347-5810
Mailing Address - Fax:307-347-5808
Practice Address - Street 1:400 SOUTH 15TH STREET
Practice Address - Street 2:
Practice Address - City:WORLAND
Practice Address - State:WY
Practice Address - Zip Code:82401
Practice Address - Country:US
Practice Address - Phone:307-347-5810
Practice Address - Fax:307-347-5808
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY270363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
970029356OtherRAILROAD MEDICARE
WY102379900Medicaid
WY311481OtherBLUE CROSS BLUE SHIELD
970029356OtherRAILROAD MEDICARE
WYW22887Medicare PIN
WY311481OtherBLUE CROSS BLUE SHIELD
W9187Medicare PIN