Provider Demographics
NPI:1083611941
Name:GATES, LANCER GENTRY (DO)
Entity Type:Individual
Prefix:DR
First Name:LANCER
Middle Name:GENTRY
Last Name:GATES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2750 CLAY EDWARDS DR STE 200A
Mailing Address - Street 2:
Mailing Address - City:N KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116-3237
Mailing Address - Country:US
Mailing Address - Phone:816-968-9320
Mailing Address - Fax:
Practice Address - Street 1:2750 CLAY EDWARDS DR STE 200A
Practice Address - Street 2:
Practice Address - City:NORTH KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-3237
Practice Address - Country:US
Practice Address - Phone:816-968-9320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-06
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000174342207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO245309117Medicaid
MO28043027OtherBLUE SHIELD KANSAS CITY
KS200304460AMedicaid
MO5400729OtherAETNA
KS200304460AMedicaid
MOG86533Medicare UPIN
MO110241145Medicare PIN