Healthcare Provider Details

I. General information

NPI: 1639195357
Provider Name (Legal Business Name): CHRISTIAN R DEQUET D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 E 2ND ST
CASPER WY
82609-4293
US

IV. Provider business mailing address

PO BOX 846266
LOS ANGELES CA
90084-6266
US

V. Phone/Fax

Practice location:
  • Phone: 307-235-5433
  • Fax: 307-233-4700
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number15775
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number17859A
License Number StateWY
# 3
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number20A7412
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number188300
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: