Provider Demographics
NPI:1295927655
Name:SPECIALISTS IN OBSTETRICS AND GYNECOLOGY, P.C.
Entity type:Organization
Organization Name:SPECIALISTS IN OBSTETRICS AND GYNECOLOGY, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TOBY
Authorized Official - Middle Name:R
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-686-3855
Mailing Address - Street 1:1414 W 4TH ST
Mailing Address - Street 2:OBGYN SPECIALISTS
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82716-3855
Mailing Address - Country:US
Mailing Address - Phone:307-686-3855
Mailing Address - Fax:307-686-8190
Practice Address - Street 1:1414 W 4TH ST
Practice Address - Street 2:OBGYN SPECIALISTS
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716-3855
Practice Address - Country:US
Practice Address - Phone:307-686-3855
Practice Address - Fax:307-686-8190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-09
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY6859A207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY315261OtherWY BCBS
H97283Medicare UPIN