Healthcare Provider Details

I. General information

NPI: 1306700588
Provider Name (Legal Business Name): WYCO DERM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5451 E. HARMONY BUILDING 2 UNIT 109
TIMNATH CO
82001-3830
US

IV. Provider business mailing address

2112 SEYMOUR AVE
CHEYENNE WY
82001-3830
US

V. Phone/Fax

Practice location:
  • Phone: 307-635-8299
  • Fax: 307-635-6984
Mailing address:
  • Phone: 307-635-8299
  • Fax: 307-635-6984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207NI0002X
TaxonomyClinical & Laboratory Dermatological Immunology Physician
License Number
License Number State

VIII. Authorized Official

Name: GREGORY SEITZ
Title or Position: OWNER
Credential:
Phone: 307-635-8299