Provider Demographics
NPI:1992011407
Name:KRIS CANFIELD, MD, PC
Entity type:Organization
Organization Name:KRIS CANFIELD, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:KRIS
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:CANFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-682-7500
Mailing Address - Street 1:PO BOX 967
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82717-0967
Mailing Address - Country:US
Mailing Address - Phone:307-682-7500
Mailing Address - Fax:307-682-7585
Practice Address - Street 1:1001 S DOUGLAS HWY
Practice Address - Street 2:BUITE B5
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716-4924
Practice Address - Country:US
Practice Address - Phone:307-682-7500
Practice Address - Fax:307-682-7585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-20
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSK00-29-6430276400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit