Provider Demographics
NPI:1760437263
Name:OVERMYER, CATHIE GANTNER (MD)
Entity type:Individual
Prefix:
First Name:CATHIE
Middle Name:GANTNER
Last Name:OVERMYER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CATHIE
Other - Middle Name:
Other - Last Name:GANTNER-OVERMYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 428
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83001-0428
Mailing Address - Country:US
Mailing Address - Phone:307-733-3636
Mailing Address - Fax:877-205-2024
Practice Address - Street 1:555 E BROADWAY AVE STE 201
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:WY
Practice Address - Zip Code:83001-8640
Practice Address - Country:US
Practice Address - Phone:307-733-7222
Practice Address - Fax:307-739-4828
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY16939A207R00000X
IL036083495207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF25081Medicare UPIN