Individual
AGESELAOS JOHN MEARES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1760 PRAIRIE AVE STE 100, CHEYENNE, WY 82009-4833
(307) 263-4022
(307) 263-4023
Mailing address
1760 PRAIRIE AVE STE 100, CHEYENNE, WY 82009-4833
(307) 263-4022
(307) 263-4023
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
7059A
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
119972200
—
WY
01
—
7059A
STATE LICENSE
WY
01
—
719AJM04
SUBSTANCE CONTROL
WY
Enumeration date
12/06/2005
Last updated
11/11/2022
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