Individual
AMY LYNN GRUBER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
214 E 23RD ST, CHEYENNE, WY 82001-3748
(307) 633-7952
Mailing address
PO BOX 20970, CHEYENNE, WY 82003-7020
(307) 633-7952
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
3034A
WY
207QH0002X
Hospice and Palliative Medicine (Family Medicine) Physician
Primary
3034A
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080001975
RR MEDICARE
—
05
—
105061300
—
WY
01
—
301252
BCBS
WY
Enumeration date
08/17/2006
Last updated
05/05/2016
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