Provider Demographics
NPI:1821779810
Name:DR. PAULUS LLC
Entity Type:Organization
Organization Name:DR. PAULUS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERNIST / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:B
Authorized Official - Last Name:PAULUS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:307-221-0340
Mailing Address - Street 1:2533 MOONLIGHT CT
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-8577
Mailing Address - Country:US
Mailing Address - Phone:307-221-0340
Mailing Address - Fax:
Practice Address - Street 1:1401 AIRPORT PKWY STE 100
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-1522
Practice Address - Country:US
Practice Address - Phone:307-369-2572
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1841200797OtherNPI FOR DR JOHN B PAULUS
10750446OtherCAQH NUMBER FOR DR. JOHN B PAULUS
WY10293AOtherWYOMING STATE MEDICAL LICENSE OF DR. JOHN B PAULUS