Provider Demographics
NPI:1467463216
Name:MEARS, GREGORY HOLT (DO)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:HOLT
Last Name:MEARS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:200 ARCO PL
Mailing Address - Street 2:SUITE 333
Mailing Address - City:INDEPENDENCE
Mailing Address - State:KS
Mailing Address - Zip Code:67301-3398
Mailing Address - Country:US
Mailing Address - Phone:620-331-5440
Mailing Address - Fax:620-331-3791
Practice Address - Street 1:200 ARCO PL
Practice Address - Street 2:SUITE 333
Practice Address - City:INDEPENDENCE
Practice Address - State:KS
Practice Address - Zip Code:67301-3398
Practice Address - Country:US
Practice Address - Phone:620-331-5440
Practice Address - Fax:620-331-3791
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS05-21870207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS101292Medicare ID - Type UnspecifiedINDIVIDUAL #
KSB48903Medicare UPIN
KS110687Medicare ID - Type UnspecifiedGROUP #