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General NPI Number Information
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NPI Number | 1053342956
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Entity Type | Individual
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Provider Name | REBECCA L. GERNON MD
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Gender | Female
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Dates
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Enumeration Date | 07/06/2006
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Last Update Date | 05/02/2014
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Provider Practice Location Address
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Address Line | 7301 E FRONTAGE RD SUITE 100
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City | SHAWNEE MISSION
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State | KS
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Zip | 66204-1654
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Country | US
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Telephone | 913-789-1940
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Fax | 913-384-4093
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Provider Business Mailing Address
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Address Line | 15977 COLLECTION CENTER DR
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City | CHICAGO
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State | IL
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Zip | 60693-0159
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Country | US
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Telephone | 800-737-5654
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Fax | 423-855-5046
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 04-31472
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License Number State | KS
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