Provider Demographics
NPI:1194798306
Name:ESTEP, GERALD J (MD)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:J
Last Name:ESTEP
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 1:627 N LONGFORD LN
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-1817
Mailing Address - Country:US
Mailing Address - Phone:303-807-3401
Mailing Address - Fax:
Practice Address - Street 1:627 N LONGFORD LN
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-1817
Practice Address - Country:US
Practice Address - Phone:303-807-3401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2016-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-37560146D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01268333Medicaid
UTZ3285Medicaid
WY122681900Medicaid
AZ128299Medicaid
NMS1893Medicaid
KS200384230AMedicaid
COE34144Medicare UPIN
NMS1893Medicaid