Provider Demographics
NPI:1891010666
Name:LAGALLE, CRYSTAL D (DO)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:D
Last Name:LAGALLE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 CLAY EDWARDS DR.
Mailing Address - Street 2:STE 400
Mailing Address - City:NORTH KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116
Mailing Address - Country:US
Mailing Address - Phone:816-421-4240
Mailing Address - Fax:816-421-5015
Practice Address - Street 1:2700 CLAY EDWARDS DR
Practice Address - Street 2:STE 400
Practice Address - City:NORTH KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116
Practice Address - Country:US
Practice Address - Phone:816-421-4240
Practice Address - Fax:816-421-5015
Is Sole Proprietor?:No
Enumeration Date:2010-04-05
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014011936207R00000X
OK0208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOE69000013Medicare UPIN