Provider Demographics
NPI:1053388611
Name:GWYN, DAVID T (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:T
Last Name:GWYN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:9828 E SHANNON WOODS CIR # 100
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-4100
Mailing Address - Country:US
Mailing Address - Phone:316-631-1600
Mailing Address - Fax:316-631-1664
Practice Address - Street 1:9828 E SHANNON WOODS CIR # 100
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-4100
Practice Address - Country:US
Practice Address - Phone:316-631-1600
Practice Address - Fax:316-631-1664
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-28302207XS0106X, 2086S0105X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200266490AMedicaid
KS103952Medicare ID - Type Unspecified
KS200266490AMedicaid