Provider Demographics
NPI:1023451648
Name:PEDRI, TONY G (MD)
Entity type:Individual
Prefix:DR
First Name:TONY
Middle Name:G
Last Name:PEDRI
Suffix:
Gender:M
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:PO BOX 1359
Mailing Address - Street 2:
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82902-1359
Mailing Address - Country:US
Mailing Address - Phone:307-212-7770
Mailing Address - Fax:307-352-8583
Practice Address - Street 1:1180 COLLEGE DR
Practice Address - Street 2:
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901
Practice Address - Country:US
Practice Address - Phone:307-212-7770
Practice Address - Fax:307-352-8583
Is Sole Proprietor?:No
Enumeration Date:2013-04-12
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN63335207X00000X
NM390200000X
WY12430A207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program