Individual
DR. JERRY ROBERT REALING
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1233 E 2ND ST, CASPER, WY 82601-2926
(307) 333-6910
(307) 333-6912
Mailing address
PO BOX 50770, CASPER, WY 82605-0770
(307) 333-6910
(307) 333-6912
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
5078
NE
207P00000X
Emergency Medicine Physician
Primary
7785A
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06273520
—
MS
05
—
124556200
—
WY
05
—
455571
—
AZ
01
—
P00424701
RAILROAD MEDICARE
—
Enumeration date
04/19/2007
Last updated
03/22/2019
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