Provider Demographics
NPI:1063411031
Name:GENGLER, JON S (MD)
Entity type:Individual
Prefix:DR
First Name:JON
Middle Name:S
Last Name:GENGLER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2750 CLAY EDWARDS DR
Mailing Address - Street 2:SUITE 312
Mailing Address - City:NORTH KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116-3237
Mailing Address - Country:US
Mailing Address - Phone:816-453-4000
Mailing Address - Fax:816-842-1425
Practice Address - Street 1:2750 CLAY EDWARDS DR
Practice Address - Street 2:SUITE 312
Practice Address - City:NORTH KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-3237
Practice Address - Country:US
Practice Address - Phone:816-453-4000
Practice Address - Fax:816-842-1425
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO1022422086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOF62212Medicare UPIN
MO2647975ABMedicare ID - Type UnspecifiedMEDICARE INDIVIDUAL