Provider Demographics
NPI:1376658104
Name:CHYNOWETH, MATTHEW D (DO)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:D
Last Name:CHYNOWETH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4850 CHINOOK TRL
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82604-5201
Mailing Address - Country:US
Mailing Address - Phone:307-473-8173
Mailing Address - Fax:
Practice Address - Street 1:4850 CHINOOK TRL
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82604-5201
Practice Address - Country:US
Practice Address - Phone:307-473-8173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY7192A170100000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical Genetics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY121629500Medicaid