Provider Demographics
NPI:1902889280
Name:CIANFLONE, ALEXANDER G (MD)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:G
Last Name:CIANFLONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ALEXANDER
Other - Middle Name:GREGORY
Other - Last Name:CIANFLONE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 2570
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-2570
Mailing Address - Country:US
Mailing Address - Phone:719-369-3357
Mailing Address - Fax:
Practice Address - Street 1:777 AVENUE H
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:WY
Practice Address - Zip Code:82435-2260
Practice Address - Country:US
Practice Address - Phone:307-754-1107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-21
Last Update Date:2013-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY5280A207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY1902889280Medicaid
CO01226752Medicaid
WY314534OtherBSWY
COD24145Medicare UPIN
WY1902889280Medicaid
CO486488Medicare PIN
WY314534OtherBSWY