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Individual

GARY W MCEWEN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
276 NE TUDOR RD, LEE'S SUMMIT, MO 64086-5696
(816) 525-8500
(816) 525-0185
Mailing address
276 NE TUDOR RD, LEE'S SUMMIT, MO 64086-5696
(816) 525-8500
(816) 525-0185

Taxonomy

Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
R9N60
MO
207ND0101X
MOHS-Micrographic Surgery Physician
R9N30
MO
207NP0225X
Pediatric Dermatology Physician
R9N30
MO
207NS0135X
Procedural Dermatology Physician
R9N30
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
P00412861
RAILROAD PTAN
MO
Enumeration date
08/10/2005
Last updated
08/22/2008
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