Provider Demographics
NPI:1497789093
Name:DEARING, PAUL D (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:D
Last Name:DEARING
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:PO BOX 3799
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82717-3799
Mailing Address - Country:US
Mailing Address - Phone:307-687-0030
Mailing Address - Fax:307-687-0044
Practice Address - Street 1:501 S BURMA AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716-3426
Practice Address - Country:US
Practice Address - Phone:307-687-0030
Practice Address - Fax:307-687-0044
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY6966A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY313290OtherBLUE CROSS BLUE SHIELD WY
E69396Medicare UPIN
WYW20120Medicare ID - Type Unspecified