Provider Demographics
NPI:1730392598
Name:SAID, JONATHAN R (PA-C)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:R
Last Name:SAID
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1479
Mailing Address - Street 2:
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82902-1479
Mailing Address - Country:US
Mailing Address - Phone:307-382-3064
Mailing Address - Fax:307-382-3033
Practice Address - Street 1:103 W 3RD ST
Practice Address - Street 2:
Practice Address - City:BIG PINEY
Practice Address - State:WY
Practice Address - Zip Code:83113-5022
Practice Address - Country:US
Practice Address - Phone:307-176-3306
Practice Address - Fax:307-276-3324
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WYTL367363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY314023OtherBLUE CROSS BLUE SHIELD
WY122130200Medicaid
WYQ58648Medicare UPIN