Organization
GARY MUNDY MD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GARY D MUNDY MD (OWNER)
(307) 673-7560
Entity
Organization
Contact information
Practice address
1955 COFFEEN AVE, SHERIDAN, WY 82801-5713
(307) 673-7560
Mailing address
1955 COFFEEN AVE, SHERIDAN, WY 82801-5713
(307) 673-7560
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
5258A
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
304445
BLUE CROSS
WY
01
—
DC7593
RAILROAD MEDICARE
WY
Enumeration date
04/24/2007
Last updated
08/22/2020
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