Individual
OLEG IVANOV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1230 E 1ST ST, CASPER, WY 82601-2704
(307) 266-3174
(307) 266-3177
Mailing address
1230 E 1ST ST, CASPER, WY 82601-2704
(307) 266-3174
(307) 266-3177
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
8672A
WY
Other
Enumeration date
07/02/2008
Last updated
07/29/2011
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