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Organization
FAMILY CLINIC
Active
Organization
FAMILY CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DANA R IDEEN MD (MANAGING MEMBER)
(307) 235-8552
Entity
Organization
Contact information
Practice address
1315 E A ST, CASPER, WY 82601-2212
(307) 235-8552
(307) 235-4656
Mailing address
1315 E A ST, CASPER, WY 82601-2212
(307) 235-8552
(307) 235-4656
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102746800
—
WY
Enumeration date
02/26/2007
Last updated
11/11/2010
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