Provider Demographics
NPI:1558396911
Name:HESS, GARY MAX (CRNA)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:MAX
Last Name:HESS
Suffix:
Gender:M
Credentials:CRNA
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 124
Mailing Address - Street 2:192 BROOKVIEW LANE
Mailing Address - City:SMOOT
Mailing Address - State:WY
Mailing Address - Zip Code:83126-0124
Mailing Address - Country:US
Mailing Address - Phone:307-886-3388
Mailing Address - Fax:
Practice Address - Street 1:STAR VALLEY MEDICAL CENTER
Practice Address - Street 2:110 HOSPITAL LANE
Practice Address - City:AFTON
Practice Address - State:WY
Practice Address - Zip Code:83110
Practice Address - Country:US
Practice Address - Phone:307-885-5800
Practice Address - Fax:307-885-5282
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY9702.0518367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI113582100Medicaid
WYS90315Medicare UPIN
WI113582100Medicaid