Provider Demographics
NPI:1770574261
Name:DEMOSS, ELEANOR PASCUAL (MD)
Entity type:Individual
Prefix:
First Name:ELEANOR
Middle Name:PASCUAL
Last Name:DEMOSS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2318 E CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-4436
Mailing Address - Country:US
Mailing Address - Phone:316-262-2415
Mailing Address - Fax:316-262-0318
Practice Address - Street 1:2318 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-4436
Practice Address - Country:US
Practice Address - Phone:316-262-2415
Practice Address - Fax:316-262-0318
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS16984208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100212200BMedicaid
KS100212200BMedicaid