Provider Demographics
NPI:1922162536
Name:HEDIGER, ROY G (MD)
Entity Type:Individual
Prefix:
First Name:ROY
Middle Name:G
Last Name:HEDIGER
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 1:295 GARFIELD ST
Mailing Address - Street 2:
Mailing Address - City:LANDER
Mailing Address - State:WY
Mailing Address - Zip Code:82520
Mailing Address - Country:US
Mailing Address - Phone:307-332-2357
Mailing Address - Fax:307-332-4276
Practice Address - Street 1:295 GARFIELD ST
Practice Address - Street 2:
Practice Address - City:LANDER
Practice Address - State:WY
Practice Address - Zip Code:82520
Practice Address - Country:US
Practice Address - Phone:307-335-6451
Practice Address - Fax:307-335-6467
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY5780A2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY112002600Medicaid
F54883Medicare UPIN
WYW303986Medicare PIN