Individual
BRADLEY GREGG HANEBRINK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1401 W 5TH ST, SHERIDAN MEMORIAL HOSPITAL, SHERIDAN, WY 82801-2705
(307) 672-1000
Mailing address
PO BOX 767, SHERIDAN, WY 82801-0767
(307) 674-5123
(307) 674-5230
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
5140A
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103008600
—
WY
01
—
305980
BCBS OF WYOMING
WY
Enumeration date
09/29/2006
Last updated
05/20/2008
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