Provider Demographics
NPI:1376571570
Name:MCNAMARA, GERALD R (MD)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:R
Last Name:MCNAMARA
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 1:12639 OLD TESSON RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2786
Mailing Address - Country:US
Mailing Address - Phone:314-849-0311
Mailing Address - Fax:314-849-4423
Practice Address - Street 1:10701 NALL AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1231
Practice Address - Country:US
Practice Address - Phone:913-381-5225
Practice Address - Fax:913-901-0186
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS0419838207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
P01049729OtherRAILROAD MEDICARE
10340073OtherBCBS KC
10340073OtherBCBS OTHER
10340073OtherBCBS OTHER
P01049729OtherRAILROAD MEDICARE
MOMA3774020Medicare PIN