Provider Demographics
NPI:1760475115
Name:DAREY, ROLAND M JR (MD)
Entity Type:Individual
Prefix:
First Name:ROLAND
Middle Name:M
Last Name:DAREY
Suffix:JR
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 1:711 GENN DR
Mailing Address - Street 2:
Mailing Address - City:WAMEGO
Mailing Address - State:KS
Mailing Address - Zip Code:66547-1179
Mailing Address - Country:US
Mailing Address - Phone:785-456-2295
Mailing Address - Fax:785-456-9467
Practice Address - Street 1:711 GENN DR
Practice Address - Street 2:
Practice Address - City:WAMEGO
Practice Address - State:KS
Practice Address - Zip Code:66547-1179
Practice Address - Country:US
Practice Address - Phone:785-456-2295
Practice Address - Fax:785-456-9467
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0430151207SG0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS0430151OtherKANSAS LICENSE
BD6855158OtherDEA
BD6855158OtherDEA
KS0430151OtherKANSAS LICENSE