Provider Demographics
NPI:1134120223
Name:MARKWAY, GREGORY ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:ALAN
Last Name:MARKWAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:19101 E VALLEY VIEW PKWY STE D
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-6907
Mailing Address - Country:US
Mailing Address - Phone:816-257-0507
Mailing Address - Fax:816-257-1200
Practice Address - Street 1:19101 E VALLEY VIEW PKWY STE D
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-6907
Practice Address - Country:US
Practice Address - Phone:816-257-0507
Practice Address - Fax:816-257-1200
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMD R4D97207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D16922Medicare UPIN
J320000Medicare ID - Type Unspecified