Provider Demographics
NPI:1497756118
Name:CESKO, DAVID R (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:R
Last Name:CESKO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CESKO
Other - Middle Name:FAMILY
Other - Last Name:PRACTICE PC
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:819 W MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:RAWLINS
Mailing Address - State:WY
Mailing Address - Zip Code:82301-5462
Mailing Address - Country:US
Mailing Address - Phone:307-324-3667
Mailing Address - Fax:307-324-5591
Practice Address - Street 1:819 W MAPLE ST
Practice Address - Street 2:
Practice Address - City:RAWLINS
Practice Address - State:WY
Practice Address - Zip Code:82301-5462
Practice Address - Country:US
Practice Address - Phone:307-324-3667
Practice Address - Fax:307-324-5591
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-03
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY5910A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY11270550Medicaid
WY11270550Medicaid