Individual
JEAN DENISE BASTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2301 HOUSE AVE, SUITE 505, CHEYENNE, WY 82001-3179
(307) 632-9261
(307) 634-9170
Mailing address
2301 HOUSE AVE, SUITE 505, CHEYENNE, WY 82001-3179
(307) 632-9261
(307) 634-9170
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
6885A
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0726680001
DMERC
—
05
—
118705800
—
WY
01
—
312232
BLUE CROSS BLUE SHIELD
WY
01
—
82001A004
TRICARE
WY
01
—
P00061023
RAILROAD MEDICARE
—
Enumeration date
09/13/2005
Last updated
10/29/2007
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