Provider Demographics
NPI:1104813930
Name:MAYER, THOMAS OTTO (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:OTTO
Last Name:MAYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 MYDLAND RD
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-2186
Mailing Address - Country:US
Mailing Address - Phone:307-673-6300
Mailing Address - Fax:307-673-6303
Practice Address - Street 1:1050 MYDLAND RD
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-2186
Practice Address - Country:US
Practice Address - Phone:307-673-6300
Practice Address - Fax:307-673-6303
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY6950A2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY05696001OtherBCBS CLINIC NUMBER
WY313252OtherBCBS INDIVIDUAL
WY119441100Medicaid
148019300OtherFEDERAL WORKERS COMPENSAT
WY120469600Medicaid
20127Medicare ID - Type UnspecifiedINDIVIDUAL
WY05696001OtherBCBS CLINIC NUMBER
P00184005Medicare ID - Type UnspecifiedRR MEDICARE
WY119441100Medicaid
WY120469600Medicaid