Healthcare Provider Details

I. General information

NPI: 1013012467
Provider Name (Legal Business Name): KENT KLEPPINGER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1252 N 22ND ST SUITE B
LARAMIE WY
82072-5306
US

IV. Provider business mailing address

1252 N 22ND ST SUITE B
LARAMIE WY
82072-5306
US

V. Phone/Fax

Practice location:
  • Phone: 307-745-3704
  • Fax: 307-745-7237
Mailing address:
  • Phone: 307-745-3704
  • Fax: 307-745-7237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number3771A
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: