Basic Information
| Provider Information | |||||||||
| NPI: | 1003801051 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COURNOYER | ||||||||
| FirstName: | GERARD | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1208 HILLTOP DR | ||||||||
| Address2: | STE 102 | ||||||||
| City: | ROCK SPRINGS | ||||||||
| State: | WY | ||||||||
| PostalCode: | 829015857 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3073829101 | ||||||||
| FaxNumber: | 3073829220 | ||||||||
| Practice Location | |||||||||
| Address1: | 1208 HILLTOP DR | ||||||||
| Address2: | STE 102 | ||||||||
| City: | ROCK SPRINGS | ||||||||
| State: | WY | ||||||||
| PostalCode: | 829015857 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3073829101 | ||||||||
| FaxNumber: | 3073829220 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2005 | ||||||||
| LastUpdateDate: | 12/18/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 5467A | WY | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 306857 | 01 | WY | BCBS OF WYO | OTHER |