Provider Demographics
NPI:1679540835
Name:SLAVENS, GARY D (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:D
Last Name:SLAVENS
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:PO BOX 806
Mailing Address - Street 2:1535 SOUTH RANGE AVENUE
Mailing Address - City:COLBY
Mailing Address - State:KS
Mailing Address - Zip Code:67701-0806
Mailing Address - Country:US
Mailing Address - Phone:785-460-8000
Mailing Address - Fax:785-460-8001
Practice Address - Street 1:1535 S RANGE AVE.
Practice Address - Street 2:
Practice Address - City:COLBY
Practice Address - State:KS
Practice Address - Zip Code:67701-0806
Practice Address - Country:US
Practice Address - Phone:785-460-8000
Practice Address - Fax:785-460-8001
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0430102207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200003980BMedicaid
200893545OtherWPS TRICARE
KS0000104556OtherBCBS
H96202Medicare UPIN
KS104556Medicare ID - Type Unspecified
KS200003980BMedicaid