Healthcare Provider Details

I. General information

NPI: 1437259272
Provider Name (Legal Business Name): SOUTHEAST WYOMING RADIATION ONCOLOGY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 11/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 E 23RD ST
CHEYENNE WY
82001-3748
US

IV. Provider business mailing address

1920 EVANS AVE
CHEYENNE WY
82001-3716
US

V. Phone/Fax

Practice location:
  • Phone: 307-633-7823
  • Fax: 307-633-7818
Mailing address:
  • Phone: 307-637-5339
  • Fax: 307-637-4525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY C CARLTON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 307-633-7823