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NPI Code Detail

MEDICARE: DR. LANCER GENTRY GATES D.O.

MEDICARE: DR. LANCER GENTRY GATES D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician2000174342MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
228043027OTHERMOBLUE SHIELD KANSAS CITY
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
45400729OTHERMOAETNA

General Provider Information

NPI Number : 1083611941
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LANCER GENTRY GATES D.O.
Provider Business Mailing Address
First Line : 2750 CLAY EDWARDS DR STE 200A
Second Line :
City : N KANSAS CITY
State : MO
Zip : 64116-3237
Country : US
Telephone Number : 816-968-9320
Fax Number :
Provider Business Practice Location Address
First Line : 2750 CLAY EDWARDS DR STE 200A
Second Line :
City : NORTH KANSAS CITY
State : MO
Zip : 64116-3237
Country : US
Telephone Number : 816-968-9320
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/06/2005
Last Update Date : 11/05/2007

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Directions to “ DR. LANCER GENTRY GATES D.O.” Practice Location

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