Provider Demographics
NPI:1598773368
Name:HEALEY, JOHN P (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:HEALEY
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 1:820 E. 17TH STREET
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-4797
Mailing Address - Country:US
Mailing Address - Phone:307-777-7911
Mailing Address - Fax:307-634-3510
Practice Address - Street 1:820 E 17TH ST
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-4714
Practice Address - Country:US
Practice Address - Phone:307-777-7911
Practice Address - Fax:307-634-3510
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY5105A207PE0004X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY108354600Medicaid
WY108354600Medicaid
WYF61296Medicare UPIN
F61296Medicare UPIN