Individual
RONALD IVERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1233 E 2ND ST, CASPER, WY 82601-2926
(307) 333-6910
(307) 333-6912
Mailing address
PO BOX 50770, CASPER, WY 82605-0770
(307) 333-6910
(307) 333-6912
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
3485A
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104439700
—
WY
01
—
305753
BLUE SHIELD
WY
01
—
307785
BLUE SHIELD
WY
01
—
82601D018
WPS TRIWEST
WY
01
—
930013242
RAILROAD MEDICARE
WY
01
—
930067310
RAILROAD MEDICARE
WY
Enumeration date
07/23/2006
Last updated
05/30/2019
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