Individual
MR. LARRY J HATTEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3235 SPARKS RD, SUITE 200, CHEYENNE, WY 82001-6158
(307) 638-8975
(307) 634-9267
Mailing address
4003 RAWLINS ST., CHEYENNE, WY 82001-1800
(307) 638-8975
(307) 634-9267
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
4666A
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1629019351
—
WY
01
—
P00720533
RAILROAD MEDICARE - PALMETTO GBA
WY
Enumeration date
06/10/2006
Last updated
02/01/2012
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