Provider Demographics
NPI:1891726626
Name:NEUWIRTH, ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:NEUWIRTH
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:P.O. BOX 3011
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82717
Mailing Address - Country:US
Mailing Address - Phone:307-688-3535
Mailing Address - Fax:307-688-3528
Practice Address - Street 1:501 S. BURMA AVE
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716
Practice Address - Country:US
Practice Address - Phone:307-688-3535
Practice Address - Fax:307-688-3528
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY7361A207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY123399800Medicaid
WYA63363Medicare UPIN
WY21253Medicare PIN