Healthcare Provider Details

I. General information

NPI: 1922162536
Provider Name (Legal Business Name): ROY G HEDIGER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 12/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 GARFIELD ST
LANDER WY
82520
US

IV. Provider business mailing address

295 GARFIELD ST
LANDER WY
82520
US

V. Phone/Fax

Practice location:
  • Phone: 307-335-6451
  • Fax: 307-335-6467
Mailing address:
  • Phone: 307-332-2357
  • Fax: 307-332-4276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number5780A
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: