Provider Demographics
NPI:1760654651
Name:SJOSTROM, REBECCA ASHLEY (MD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ASHLEY
Last Name:SJOSTROM
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:970 W BROADWAY STE E
Mailing Address - Street 2:#121
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83001-6403
Mailing Address - Country:US
Mailing Address - Phone:307-699-6801
Mailing Address - Fax:307-733-6912
Practice Address - Street 1:945 W BROADWAY AVE
Practice Address - Street 2:STE 202
Practice Address - City:JACKSON
Practice Address - State:WY
Practice Address - Zip Code:83001-8217
Practice Address - Country:US
Practice Address - Phone:307-699-6801
Practice Address - Fax:307-733-6912
Is Sole Proprietor?:No
Enumeration Date:2008-03-31
Last Update Date:2023-08-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AK8081207X00000X
CO48707207X00000X
WY13178A207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO48707OtherCOLORADO MEDICAL LICENSE
WY13178AOtherWY MEDICAL LICENSE
AK8081OtherALASKA MEDICAL LICENSE