Provider Demographics
NPI:1811401821
Name:COWBOY MEDICAL GROUP PC
Entity Type:Organization
Organization Name:COWBOY MEDICAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:C
Authorized Official - Last Name:WEYER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:307-864-5534
Mailing Address - Street 1:1125 CHARLES AVE
Mailing Address - Street 2:
Mailing Address - City:WORLAND
Mailing Address - State:WY
Mailing Address - Zip Code:82401-4021
Mailing Address - Country:US
Mailing Address - Phone:307-347-2449
Mailing Address - Fax:
Practice Address - Street 1:1125 CHARLES AVE
Practice Address - Street 2:
Practice Address - City:WORLAND
Practice Address - State:WY
Practice Address - Zip Code:82401-4021
Practice Address - Country:US
Practice Address - Phone:307-347-2449
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-29
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty