Provider Demographics
NPI:1053426759
Name:TOOKE, JOHNNY M (MD)
Entity type:Individual
Prefix:DR
First Name:JOHNNY
Middle Name:M
Last Name:TOOKE
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 1:2241 FARNUM STE 105
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82609
Mailing Address - Country:US
Mailing Address - Phone:307-266-1263
Mailing Address - Fax:307-265-0410
Practice Address - Street 1:2241 FARNUM STE 105
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609
Practice Address - Country:US
Practice Address - Phone:307-266-1263
Practice Address - Fax:307-265-0410
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY2522A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY103999700Medicaid
WY103999700Medicaid
WY9351Medicare ID - Type Unspecified