Provider Demographics
NPI:1164865796
Name:GEBHART, SANDRA SUSANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:SUSANNE
Last Name:GEBHART
Suffix:
Gender:F
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:PO BOX 688
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:WY
Mailing Address - Zip Code:82633-0688
Mailing Address - Country:US
Mailing Address - Phone:307-358-6200
Mailing Address - Fax:314-747-2598
Practice Address - Street 1:2901 POWDER BASIN AVE
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82718-6406
Practice Address - Country:US
Practice Address - Phone:307-682-6222
Practice Address - Fax:307-682-6999
Is Sole Proprietor?:No
Enumeration Date:2013-04-13
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018013765207X00000X
WY12214A207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery