Provider Demographics
NPI:1992898308
Name:GAMMILL, DEBORAH J (MD)
Entity type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:J
Last Name:GAMMILL
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 1:1000 CARONDELET DR
Mailing Address - Street 2:PROVIDER ENROLLMENT/ MED STAFF OFC
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114
Mailing Address - Country:US
Mailing Address - Phone:816-943-5744
Mailing Address - Fax:
Practice Address - Street 1:15604 PINEHURST DRIVE
Practice Address - Street 2:SUITE 2
Practice Address - City:BASEHOR
Practice Address - State:KS
Practice Address - Zip Code:66007
Practice Address - Country:US
Practice Address - Phone:913-728-2200
Practice Address - Fax:913-728-2230
Is Sole Proprietor?:No
Enumeration Date:2006-09-30
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0427440207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100325690DMedicaid
KS100325690DMedicaid
80162903Medicare ID - Type UnspecifiedRAILROAD
25264046OtherBCBS KANSAS
KS057930Medicare ID - Type UnspecifiedKANSAS