Provider Demographics
NPI:1336177120
Name:JAOUEN, RICHARD M (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:M
Last Name:JAOUEN
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 1:1129 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-2903
Mailing Address - Country:US
Mailing Address - Phone:307-472-4300
Mailing Address - Fax:307-265-7479
Practice Address - Street 1:1129 E 2ND ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2903
Practice Address - Country:US
Practice Address - Phone:307-472-4300
Practice Address - Fax:307-265-7479
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY2824A2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY314782OtherBLUE CROSS BLUE SHIELD
WYP00403110OtherRAILROAD MEDICARE
WY119886600Medicaid
WYW23741Medicare PIN
WYP00403110OtherRAILROAD MEDICARE