Provider Demographics
NPI:1902001506
Name:PRYPCHAN, LIDA D (MD)
Entity Type:Individual
Prefix:DR
First Name:LIDA
Middle Name:D
Last Name:PRYPCHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2521 E 15TH ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82609-4126
Mailing Address - Country:US
Mailing Address - Phone:307-237-7444
Mailing Address - Fax:307-265-5525
Practice Address - Street 1:2521 E 15TH ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609
Practice Address - Country:US
Practice Address - Phone:307-237-7444
Practice Address - Fax:307-265-5525
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY7701A2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY7701AOtherLICENSE WY