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NPI Code Detail

MEDICARE: BENGT JOSEPHSON GRUA MD

MEDICARE: BENGT JOSEPHSON GRUA MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207LP2900XPain Medicine (Anesthesiology) Physician17238AWY
2207L00000XAnesthesiology Physician21768NH
3390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1275093650
Entity Type Code : Individual
Provider Name (Legal Business Name) : BENGT JOSEPHSON GRUA MD
Provider Business Mailing Address
First Line : 1541 DIAMOND DR
Second Line :
City : CASPER
State : WY
Zip : 82601-6247
Country : US
Telephone Number : 307-232-6649
Fax Number : 307-215-0898
Provider Business Practice Location Address
First Line : 1541 DIAMOND DR
Second Line :
City : CASPER
State : WY
Zip : 82601-6247
Country : US
Telephone Number : 307-232-6649
Fax Number : 307-215-0898
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/22/2019
Last Update Date : 03/12/2026

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