Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 3771A | WY |
NPI | 1013012467 |
---|---|
Provider Name | Kent Kleppinger |
First Address | Laramie, WY 82072-5306 |
Second Address | Laramie, WY 82072-5306 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3771A | STATE LICENSE # (01) | WY |
A73158 | (02) | WY |
AK2770976 | DEA # (01) | WY |