Provider Demographics
NPI:1528491651
Name:STY, JOHN ROBERT (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:ROBERT
Last Name:STY
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:PO BOX 33
Mailing Address - Street 2:
Mailing Address - City:DEVILS TOWER
Mailing Address - State:WY
Mailing Address - Zip Code:82714-0033
Mailing Address - Country:US
Mailing Address - Phone:307-467-5861
Mailing Address - Fax:307-467-5921
Practice Address - Street 1:534 LYTLE CREEK RD
Practice Address - Street 2:
Practice Address - City:DEVILS TOWER
Practice Address - State:WY
Practice Address - Zip Code:82714-0033
Practice Address - Country:US
Practice Address - Phone:307-467-5861
Practice Address - Fax:307-467-5921
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-13
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY6982A2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology