Provider Demographics
NPI:1265449060
Name:HABERTHIER-RYAN, LUCY (MD)
Entity Type:Individual
Prefix:DR
First Name:LUCY
Middle Name:
Last Name:HABERTHIER-RYAN
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 1359
Mailing Address - Street 2:
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82902-1359
Mailing Address - Country:US
Mailing Address - Phone:307-212-7717
Mailing Address - Fax:307-212-7513
Practice Address - Street 1:1180 COLLEGE DR
Practice Address - Street 2:
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-5863
Practice Address - Country:US
Practice Address - Phone:307-212-7717
Practice Address - Fax:307-212-7513
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5094208000000X
WY12406A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0020EDOtherBLUECROSS/BLUESHIELD
TX130812404Medicaid
TX10020015OtherAMERIGROUP
TX5695001OtherAETNA
TX10020015OtherAMERIGROUP
TX130812404Medicaid