Healthcare Provider Details

I. General information

NPI: 1427168996
Provider Name (Legal Business Name): W. CARLTON RECKLING M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 12/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E 20TH ST SUITE 300
CHEYENNE WY
82001-3859
US

IV. Provider business mailing address

800 E 20TH ST SUITE 300
CHEYENNE WY
82001-3859
US

V. Phone/Fax

Practice location:
  • Phone: 307-632-6637
  • Fax: 307-632-3382
Mailing address:
  • Phone: 307-632-6637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number41285
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number35806
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number23198
License Number StateNE
# 4
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number5784A
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: