Organization
CESKO FAMILY PRACTICE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID R CESKO MD (OWNER)
(307) 324-3667
Entity
Organization
Contact information
Practice address
819 W MAPLE ST, RAWLINS, WY 82301-5462
(307) 324-3667
(307) 324-5591
Mailing address
PO BOX 40, RAWLINS, WY 82301-0040
(307) 324-3667
(307) 324-5591
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
5910A
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
112705500
—
WY
01
—
DD4463
PALMETTO ID
WY
Enumeration date
10/25/2007
Last updated
11/13/2007
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