Provider Demographics
NPI:1023402955
Name:BLUEMEL, LANDON BRUCE (MD)
Entity type:Individual
Prefix:
First Name:LANDON
Middle Name:BRUCE
Last Name:BLUEMEL
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 1:214 E 23RD ST
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-3748
Mailing Address - Country:US
Mailing Address - Phone:801-589-2016
Mailing Address - Fax:307-633-7676
Practice Address - Street 1:CHEYENNE REGIONAL MEDICAL CENTER
Practice Address - Street 2:214 E 23RD ST
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001
Practice Address - Country:US
Practice Address - Phone:801-589-2016
Practice Address - Fax:307-633-7676
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-28
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WYTL5729207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program