Healthcare Provider Details

I. General information

NPI: 1528491651
Provider Name (Legal Business Name): JOHN ROBERT STY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2013
Last Update Date: 08/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

534 LYTLE CREEK RD
DEVILS TOWER WY
82714-0033
US

IV. Provider business mailing address

PO BOX 33
DEVILS TOWER WY
82714-0033
US

V. Phone/Fax

Practice location:
  • Phone: 307-467-5861
  • Fax: 307-467-5921
Mailing address:
  • Phone: 307-467-5861
  • Fax: 307-467-5921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number6982A
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: