Healthcare Provider Details

I. General information

NPI: 1710089719
Provider Name (Legal Business Name): WILLIAM J GAREY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1527 MADISON ST
FREDONIA KS
66736-1751
US

IV. Provider business mailing address

PO BOX 1154
EL DORADO KS
67042-1154
US

V. Phone/Fax

Practice location:
  • Phone: 316-321-5900
  • Fax: 316-321-4763
Mailing address:
  • Phone: 316-321-5900
  • Fax: 316-321-4763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number04-16999
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: