Provider Demographics
NPI:1154363703
Name:GATELEY, TIMOTHY BRYAN (DPM)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:BRYAN
Last Name:GATELEY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6021 SW 29TH ST.
Mailing Address - Street 2:SUITE A BOX 352
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66614
Mailing Address - Country:US
Mailing Address - Phone:785-730-3478
Mailing Address - Fax:785-783-8983
Practice Address - Street 1:6730 SW MISSION VIEW DR
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66614-5652
Practice Address - Country:US
Practice Address - Phone:785-730-3478
Practice Address - Fax:785-783-8983
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSKS 12-00349213ES0000X
MO2005012032213ES0000X, 213ES0131X
KS12-00349213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSV04957Medicare UPIN
KS5242430001Medicare NSC
KS114116001Medicare PIN