Individual
JONATHON DOMINIQUE MEDINA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1950 BLUEGRASS CIR STE 200, CHEYENNE, WY 82009-7364
(307) 778-2577
(307) 635-2131
Mailing address
1950 BLUEGRASS CIR STE 200, CHEYENNE, WY 82009-7364
(307) 778-2577
(307) 635-2131
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
43517
CO
207Q00000X
Family Medicine Physician
Primary
7156A
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01727541
—
CO
Enumeration date
08/07/2006
Last updated
10/31/2022
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