Provider Demographics
NPI:1720746324
Name:DR. RANDY FOLKER ENT AND ALLERGY, PC
Entity Type:Organization
Organization Name:DR. RANDY FOLKER ENT AND ALLERGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEMMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-751-3366
Mailing Address - Street 1:1330 BECK AVE
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-3729
Mailing Address - Country:US
Mailing Address - Phone:307-586-5300
Mailing Address - Fax:307-586-5310
Practice Address - Street 1:1330 BECK AVE
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414
Practice Address - Country:US
Practice Address - Phone:307-586-5300
Practice Address - Fax:307-586-5310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-01
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty