
First Name
Lyle Runte
Last Name
Doe
Date of Birth
1999-06-12
Gender
Male
Phone Number
(680) 888-3110
Insurance Provider
Medhurst - Casper
Patient ID
12722
Emergency Contact
Jane Doe (+1 987 654 3210)
Street Address
123 Main St, Apt 4B
City
Denver
State/Province
Colorado
Zip Code
80202
Country
United States
Emergency Contact Address
456 Elm St, Apt 10C, Denver, CO