Provider Demographics
NPI:1750482527
Name:KRELL, GEORGE CHRISTOPHER (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:CHRISTOPHER
Last Name:KRELL
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 1:711 ONYX ST
Mailing Address - Street 2:
Mailing Address - City:KEMMERER
Mailing Address - State:WY
Mailing Address - Zip Code:83101-3214
Mailing Address - Country:US
Mailing Address - Phone:307-877-4496
Mailing Address - Fax:307-877-9769
Practice Address - Street 1:711 ONYX ST
Practice Address - Street 2:
Practice Address - City:KEMMERER
Practice Address - State:WY
Practice Address - Zip Code:83101-3214
Practice Address - Country:US
Practice Address - Phone:307-877-4496
Practice Address - Fax:307-877-9769
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY5749A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY111041100Medicaid
WY304003OtherBLUE CROSS/BLUE SHIELD
WY080103618Medicare ID - Type UnspecifiedRAILROAD MEDICARE
WY304003OtherBLUE CROSS/BLUE SHIELD
G15869Medicare UPIN