Individual
DANA RAY IDEEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1315 E A ST, CASPER, WY 82601-2212
(307) 235-8552
(307) 235-4656
Mailing address
1315 E A ST, CASPER, WY 82601-2212
(307) 235-8552
(307) 235-4656
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
3742A
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104037500
—
WY
Enumeration date
07/28/2006
Last updated
07/08/2007
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