Provider Demographics
NPI:1851923403
Name:ROBERT A VIGNERI
Entity Type:Organization
Organization Name:ROBERT A VIGNERI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:GAMROTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-577-0465
Mailing Address - Street 1:940 E 3RD ST STE 203
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-3251
Mailing Address - Country:US
Mailing Address - Phone:307-577-0465
Mailing Address - Fax:307-577-0469
Practice Address - Street 1:940 E 3RD ST STE 203
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-3251
Practice Address - Country:US
Practice Address - Phone:307-577-0465
Practice Address - Fax:307-577-0469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-11
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty