Provider Demographics
NPI:1295782233
Name:LEGLER, GARY LEE (DO)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:LEE
Last Name:LEGLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4810 STATE AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66102-1748
Mailing Address - Country:US
Mailing Address - Phone:913-945-9740
Mailing Address - Fax:913-945-9741
Practice Address - Street 1:4810 STATE AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66102-1748
Practice Address - Country:US
Practice Address - Phone:913-945-9740
Practice Address - Fax:913-945-9741
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0517972207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSC52301Medicare UPIN