Provider Demographics
NPI:1356326540
Name:OFSTEIN, RICHARD A (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
Last Name:OFSTEIN
Suffix:
Gender:M
Credentials:MD
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Other - Last Name:
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Mailing Address - Street 1:JACKSON HOLE MEDICAL IMAGING PC
Mailing Address - Street 2:PO BOX 9230
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83002-9230
Mailing Address - Country:US
Mailing Address - Phone:800-633-1905
Mailing Address - Fax:913-491-0411
Practice Address - Street 1:ST JOHNS MEDICAL CENTER DEPT OF RADIOLOGY
Practice Address - Street 2:625 E BROADWAY
Practice Address - City:JACKSON
Practice Address - State:WY
Practice Address - Zip Code:83011
Practice Address - Country:US
Practice Address - Phone:800-633-1905
Practice Address - Fax:913-491-0411
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2021-11-10
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Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WY7287A2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY122813700Medicaid
ID807446700Medicaid
WY314177OtherBCBS