Provider Demographics
NPI:1255641122
Name:GERARD PAUL NAGORSKI DO PC
Entity type:Organization
Organization Name:GERARD PAUL NAGORSKI DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GERARD
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:NAGORSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:816-444-6554
Mailing Address - Street 1:1235 W 64TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64113-1514
Mailing Address - Country:US
Mailing Address - Phone:816-444-6554
Mailing Address - Fax:816-822-7017
Practice Address - Street 1:1235 W 64TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64113-1514
Practice Address - Country:US
Practice Address - Phone:816-444-6554
Practice Address - Fax:816-822-7017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-13
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO313762084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty