Individual
WILLIAM D KETCHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
800 E 20TH ST, SUITE 110, CHEYENNE, WY 82001-3859
(307) 634-7711
Mailing address
800 E 20TH ST, SUITE 110, CHEYENNE, WY 82001-3859
(307) 634-7711
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
40972
CO
2085R0202X
Diagnostic Radiology Physician
Primary
6803A
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
22971211
—
CO
01
—
311699
BCBS OF WYOMING CRG
WY
01
—
311700
BCBS OF WYOMING MRI
WY
Enumeration date
06/15/2006
Last updated
07/09/2007
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