Provider Demographics
NPI:1497861652
Name:CASEY, CYNTHIA MARIE (MD)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:MARIE
Last Name:CASEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:MARIE
Other - Last Name:DUNN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:430 S MEDICAL ARTS CT
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82716-3364
Mailing Address - Country:US
Mailing Address - Phone:307-685-6500
Mailing Address - Fax:307-685-3081
Practice Address - Street 1:430 S MEDICAL ARTS CT
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716-3364
Practice Address - Country:US
Practice Address - Phone:307-685-6500
Practice Address - Fax:307-685-3081
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY5804A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY111749100Medicaid
WY111749100Medicaid
WY308205Medicare ID - Type UnspecifiedMOORCROFT CLINIC
WY308207Medicare ID - Type UnspecifiedHULETT CLINIC
WYG31907Medicare UPIN