Basic Information
| Provider Information | |||||||||
| NPI: | 1538102728 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CARMEN | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | CHERRINGTON | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | II | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1715 HILLCREST DR | ||||||||
| Address2: | |||||||||
| City: | SHERIDAN | ||||||||
| State: | WY | ||||||||
| PostalCode: | 828013244 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3076735364 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1898 FORT RD | ||||||||
| Address2: | VA MEDICAL CENTER (170) | ||||||||
| City: | SHERIDAN | ||||||||
| State: | WY | ||||||||
| PostalCode: | 828018320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3076723473 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 3043A | WY | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.