Healthcare Provider Details

I. General information

NPI: 1770499428
Provider Name (Legal Business Name): CHEYENNE REGIONAL PHYSICIANS GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 HOUSE AVE STE 207
CHEYENNE WY
82001-3178
US

IV. Provider business mailing address

PO BOX 20970
CHEYENNE WY
82003-7020
US

V. Phone/Fax

Practice location:
  • Phone: 307-632-5589
  • Fax: 307-432-3691
Mailing address:
  • Phone: 307-632-5589
  • Fax: 307-432-3691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number
License Number State

VIII. Authorized Official

Name: BRAD WAYNE WHITE
Title or Position: ADMINISTRATOR OF REVENUE
Credential:
Phone: 307-633-6198