Provider Demographics
NPI:1740391010
Name:HUGH D. DEPAOLO M.D.P.C.
Entity Type:Organization
Organization Name:HUGH D. DEPAOLO M.D.P.C.
Other - Org Name:A STREET MEDICAL
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HUGH
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:DEPAOLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-235-1503
Mailing Address - Street 1:1450 E A ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-2239
Mailing Address - Country:US
Mailing Address - Phone:307-235-1503
Mailing Address - Fax:307-237-2020
Practice Address - Street 1:1450 E A ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2239
Practice Address - Country:US
Practice Address - Phone:307-235-1503
Practice Address - Fax:307-237-2020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY2883A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY302275OtherBCBS
WY9174Medicare ID - Type Unspecified
WY302275OtherBCBS