Provider Demographics
NPI:1518905595
Name:MOHR, MICHELE R (MD)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:R
Last Name:MOHR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 128
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77402-0128
Mailing Address - Country:US
Mailing Address - Phone:281-833-3330
Mailing Address - Fax:281-833-3327
Practice Address - Street 1:5715 E 2ND ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609-4322
Practice Address - Country:US
Practice Address - Phone:307-268-7717
Practice Address - Fax:307-265-2860
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY6715A207Q00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY118305200Medicaid
WYH79323Medicare UPIN
WYW9457Medicare ID - Type UnspecifiedMEDICARE