Laurence William Vale Deboer, M.D.
Individual provider Active NPI Cardiovascular Disease Physician · Gillette, WY
NPI 1043315872 · NPPES record last updated Mar 7, 2023
Key facts
- NPI
- 1043315872
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Cardiovascular Disease Physician 207RC0000X
- License
- 5853A (WY)
- Practice address
- 430 Medical Arts CT.
Gillette, WY 82716 - Phone
- (307) 682-7661
- Fax
- (307) 682-7624
- NPI assigned
- Sep 14, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No · DME: Yes · Home health: No · Power mobility devices: Yes · Hospice: No
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| E0878 | TX | MD | Cardiovascular Disease Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Antelope Medical Consultants LLC | Cardiovascular Disease | Past | Accepting new patients |
| Frances Mahon Deaconess Hospital | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cardiovascular Disease Physician | 207RC0000X | 5853A | WY | Yes |
| Cardiovascular Disease Physician | 207RC0000X | E0878 | TX |
Addresses
Primary practice location
430 Medical Arts CT.
Gillette, WY 82716
Mailing address
430 Medical Arts CT.
Gillette, WY 82716
Phone (307) 682-7661
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 638 | Other | MEDICAL LICENSE | |
| 53D925429 | Other | WY | CLIA |
| 303946 | Other | WY | BLUE CROSS |
| 5853A | Other | WY | STATE LICENSE |
| 00783001 | Other | WY | BLUE CROSS GROUP NUMBER |
| 7088727 | Medicaid | WY | |
| 8380925 | Medicaid | WA |
Other providers in Gillette, WY
- Thomas Clifford Davis
- Nancy Day
- Jean-Raphael De Raoulx
- Paul D Dearing
- Chrissy Michael Deavor
- Britta L Denman
- Dental Care Center PC
- Wendy Depina
- Craig Deuter
- Kerri Lee Dewine
All providers in Gillette, WY · Cardiovascular Disease Physician in Wyoming
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 7, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.