Provider Demographics
NPI:1629003223
Name:LIBRODO, GERARD FERNANDEZ (MD)
Entity Type:Individual
Prefix:DR
First Name:GERARD
Middle Name:FERNANDEZ
Last Name:LIBRODO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 W CENTRAL AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:KS
Mailing Address - Zip Code:67042-2187
Mailing Address - Country:US
Mailing Address - Phone:316-322-4589
Mailing Address - Fax:316-321-4810
Practice Address - Street 1:700 W CENTRAL AVE STE 105
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:KS
Practice Address - Zip Code:67042-2187
Practice Address - Country:US
Practice Address - Phone:316-322-4589
Practice Address - Fax:316-321-4810
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0431540207XS0117X
KS04-31540207X00000X, 207XP3100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200373470CMedicaid
KS0000106013OtherBLUE CROSS BLUE SHIELD
KS106013Medicare PIN