Healthcare Provider Details

I. General information

NPI: 1710086558
Provider Name (Legal Business Name): ROBERT TRAVIS NEFF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 05/04/2022
Certification Date: 05/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 S WASHINGTON ST SUITE 102
CASPER WY
82601-2951
US

IV. Provider business mailing address

419 S WASHINGTON ST SUITE 102
CASPER WY
82601-2951
US

V. Phone/Fax

Practice location:
  • Phone: 307-237-5047
  • Fax: 307-235-4017
Mailing address:
  • Phone: 307-237-5047
  • Fax: 307-235-4017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberDR.0068391
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number8158A
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: