Provider Demographics
NPI:1427168996
Name:RECKLING, W. CARLTON (MD)
Entity type:Individual
Prefix:
First Name:W. CARLTON
Middle Name:
Last Name:RECKLING
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 1:800 E 20TH ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-3859
Mailing Address - Country:US
Mailing Address - Phone:307-632-6637
Mailing Address - Fax:
Practice Address - Street 1:800 E 20TH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-3859
Practice Address - Country:US
Practice Address - Phone:307-632-6637
Practice Address - Fax:307-632-3382
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO41285207XS0117X
MN35806207XS0117X
NE23198207XS0117X
WY5784A207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY308697OtherBLUE CROSS BLUE SHIELD
WY111303800Medicaid
WY200041565OtherRAILROAD MEDICARE
WY308697Medicare ID - Type Unspecified
WYF84683Medicare UPIN