MEDICARE: DR. GARY E HRNICEK MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	5144A	WY
2	207R00000X	Internal Medicine Physician	2002026162	MO
3	207R00000X	Internal Medicine Physician	M-9139	ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5144A	OTHER	WY	MED. LIC
2	M-9139	OTHER	ID	MED LIC. M-9139
3	2002026162	OTHER	MO	MED. LIC

General Provider Information

NPI Number	:	1891889481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY E HRNICEK MD

Provider Business Mailing Address
First Line	:	1200 HAWTHORNE AVE
Second Line	:
City	:	CASPER
State	:	WY
Zip	:	82604
Country	:	US
Telephone Number	:	307-235-4066
Fax Number	:

Provider Business Practice Location Address
First Line	:	4301 MOW WAY ROAD
Second Line	:
City	:	LAWTON-FORT SILL
State	:	OK
Zip	:	73503
Country	:	US
Telephone Number	:	580-458-2243
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	09/18/2008

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