Healthcare Provider Details

I. General information

NPI: 1164865796
Provider Name (Legal Business Name): SANDRA SUSANNE GEBHART MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2013
Last Update Date: 09/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 POWDER BASIN AVE
GILLETTE WY
82718-6406
US

IV. Provider business mailing address

PO BOX 688
DOUGLAS WY
82633-0688
US

V. Phone/Fax

Practice location:
  • Phone: 307-682-6222
  • Fax: 307-682-6999
Mailing address:
  • Phone: 307-358-6200
  • Fax: 314-747-2598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number2018013765
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number12214A
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: