Individual
DR. ANN H THEDIECK
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1400 UINTA DR, GREEN RIVER, WY 82935-5046
(307) 872-4500
(307) 872-4595
Mailing address
PO BOX 219, GREEN RIVER, WY 82935-0219
(307) 872-4500
(307) 872-4595
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
6716A
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
313158
BLUE CROSS BLUE SHIELD
WY
Enumeration date
05/25/2006
Last updated
07/08/2007
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