Individual
KERRY G ENGELKING
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
10240 W POISON SPIDER RD, CASPER, WY 82604-9556
(307) 277-5502
Mailing address
111 W 2ND ST, SUITE 415, CASPER, WY 82601-2454
(307) 237-5848
(307) 237-5848
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
3569A
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
050037998
RAILROAD MEDICARE
WY
05
—
104206800
—
WY
01
—
104206801
WYOMING MEDICAID
WY
01
—
307121
BLUE SHIELD
WY
Enumeration date
10/04/2006
Last updated
10/26/2021
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