Provider Demographics
NPI:1053342956
Name:GERNON, REBECCA L (MD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:L
Last Name:GERNON
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:15977 COLLECTION CENTER DR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60693-0159
Mailing Address - Country:US
Mailing Address - Phone:800-737-5654
Mailing Address - Fax:423-855-5046
Practice Address - Street 1:7301 E FRONTAGE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SHAWNEE MISSION
Practice Address - State:KS
Practice Address - Zip Code:66204-1654
Practice Address - Country:US
Practice Address - Phone:913-789-1940
Practice Address - Fax:913-384-4093
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2014-05-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS04-31472207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00410901OtherRR MEDICARE
3591024OtherBCBSKC
75316418400OtherCHP
9339760006OtherCIGNA
I17200Medicare UPIN
9339760006OtherCIGNA