Provider Demographics
NPI:1508430521
Name:NAGELY, ROBERT GEORGE (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:GEORGE
Last Name:NAGELY
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:PO BOX 247
Mailing Address - Street 2:
Mailing Address - City:SABETHA
Mailing Address - State:KS
Mailing Address - Zip Code:66534-0247
Mailing Address - Country:US
Mailing Address - Phone:785-284-2141
Mailing Address - Fax:785-284-0220
Practice Address - Street 1:1115 MAIN ST
Practice Address - Street 2:
Practice Address - City:SABETHA
Practice Address - State:KS
Practice Address - Zip Code:66534-1832
Practice Address - Country:US
Practice Address - Phone:785-284-2141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-14
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-49880207Q00000X
KS94-10520207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS49880OtherKANSAS BOARD OF HEALING ARTS