Provider Demographics
NPI:1922441328
Name:BJORE, EMMA MARIE (MD)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:MARIE
Last Name:BJORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 N 30TH ST
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82072-5140
Mailing Address - Country:US
Mailing Address - Phone:307-755-4540
Mailing Address - Fax:307-755-4539
Practice Address - Street 1:3116 WILLETT DR
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82072-5048
Practice Address - Country:US
Practice Address - Phone:307-755-4540
Practice Address - Fax:307-755-4539
Is Sole Proprietor?:No
Enumeration Date:2013-04-16
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY11058A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine