Provider Demographics
NPI:1083842389
Name:KRANER, THOMAS ORVAL (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ORVAL
Last Name:KRANER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6206 KEVIN AVE
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-3509
Mailing Address - Country:US
Mailing Address - Phone:307-632-7879
Mailing Address - Fax:
Practice Address - Street 1:6206 KEVIN AVE
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-3509
Practice Address - Country:US
Practice Address - Phone:208-989-9993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-24
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY5601A2086S0102X, 2086S0127X, 208600000X, 2086S0127X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2089246Medicaid
DJ236OtherBLUE CROSS OF IDAHO
OR150935Medicaid
ID804302400Medicaid
000010004411OtherBLUE SHIELD OF IDAHO
020043846OtherRAILROAD MEDICARE
IDG-07389Medicare UPIN
OR150935Medicaid