Individual
GARY MIKESELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
300 3RD ST, RAWLINS, WY 82301-5612
(307) 324-8494
Mailing address
300 3RD ST, RAWLINS, WY 82301-5612
(307) 324-8494
(307) 324-8496
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
12467A
WY
207Q00000X
Family Medicine Physician
Primary
GM012991
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4498759
—
MI
Enumeration date
05/05/2006
Last updated
07/22/2020
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