Provider Demographics
NPI:1912019274
Name:SEYMOUR, GALEN L (MD)
Entity Type:Individual
Prefix:
First Name:GALEN
Middle Name:L
Last Name:SEYMOUR
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 1:3550 S 4TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66048-5009
Mailing Address - Country:US
Mailing Address - Phone:913-680-6442
Mailing Address - Fax:913-351-1346
Practice Address - Street 1:3550 S 4TH ST STE 200
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-5009
Practice Address - Country:US
Practice Address - Phone:913-680-6442
Practice Address - Fax:913-351-1346
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0431830207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS000212OtherBLUE CROSS
KS100069780FMedicaid
KS100099480AMedicaid
KS17-1320Medicare ID - Type Unspecified
KS17-Z320Medicare ID - Type Unspecified
KS100099480AMedicaid