Provider Demographics
NPI:1952349193
Name:GAYNOR, CHARLES A (LP)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:A
Last Name:GAYNOR
Suffix:
Gender:M
Credentials:LP
Other - Prefix:
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Mailing Address - Street 1:635 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-3602
Mailing Address - Country:US
Mailing Address - Phone:316-660-7600
Mailing Address - Fax:316-383-7925
Practice Address - Street 1:1919 N AMIDON AVE
Practice Address - Street 2:STE. 130
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-2117
Practice Address - Country:US
Practice Address - Phone:316-660-7675
Practice Address - Fax:316-832-1571
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS0405103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS022101OtherBLUE CROSS
KS4205OtherPREFERRED HEALTH SYSTEMS
KS2144774OtherCIGNA
KSPV115577OtherAMERICAN PSYCH SYSTEMS
KS2144774OtherCIGNA