Basic Information
| Provider Information | |||||||||
| NPI: | 1720019060 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GUERAMY | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | C. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1909 VISTA DR | ||||||||
| Address2: | |||||||||
| City: | LARAMIE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 820705530 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124391000 | ||||||||
| FaxNumber: | 5124391081 | ||||||||
| Practice Location | |||||||||
| Address1: | 1909 VISTA DR | ||||||||
| Address2: | |||||||||
| City: | LARAMIE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 820705599 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3077458851 | ||||||||
| FaxNumber: | 3077420961 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2006 | ||||||||
| LastUpdateDate: | 09/25/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/25/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | L9715 | TX | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XX0004X | L9715 | TX | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Foot and Ankle Surgery | 207X00000X | 10960A | WY | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 85263 | 01 | TX | SCOTT & WHITE | OTHER | 184372402 | 05 | TX | MEDICAID | 7475736 | 01 | TX | AETNA TRS | OTHER | 8R0760 | 01 | TX | BCBS | OTHER | 094771502 | 05 | TX | MEDICAID |