Individual
GARY W HEATH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
625 EAST BROADWAY, ST JOHNS MEDICAL CENTER DEPT OF RADIOLOGY, JACKSON, WY 83001
(800) 633-1905
Mailing address
PO BOX 9230, JACKSON, WY 83002-9230
(800) 633-1905
(913) 491-0411
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
6361A
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
310489
WYOMING BLUE
—
01
—
6361A
WY MEDICAL LICENSE
—
Enumeration date
07/31/2006
Last updated
03/07/2023
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