Healthcare Provider Details

I. General information

NPI: 1588767164
Provider Name (Legal Business Name): RICHARD ALLAN GELLENDER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

2724 NORTH JOPLIN
PITTSBURG KS
66762
US

IV. Provider business mailing address

2724 NORTH JOPLIN
PITTSBURG KS
66762
US

V. Phone/Fax

Practice location:
  • Phone: 620-231-7190
  • Fax: 620-231-7192
Mailing address:
  • Phone: 620-231-7190
  • Fax: 620-231-7192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number14934
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: