Provider Demographics
NPI:1538268305
Name:CARLTON, JEFFREY C (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:C
Last Name:CARLTON
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 1:1920 EVANS AVE
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-3716
Mailing Address - Country:US
Mailing Address - Phone:307-637-5339
Mailing Address - Fax:307-637-4525
Practice Address - Street 1:214 E 23RD ST
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-3748
Practice Address - Country:US
Practice Address - Phone:307-633-7823
Practice Address - Fax:307-633-7818
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY5473A2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY307462OtherBLUE CROSS BLUE SHIELD
WY307462OtherBLUE CROSS BLUE SHIELD
F88626Medicare UPIN