Basic Information
| Provider Information | |||||||||
| NPI: | 1366457038 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RIEMER | ||||||||
| FirstName: | GUSTAV | ||||||||
| MiddleName: | THOMAS | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9119 W. 74TH STREET, SUITE 354 | ||||||||
| Address2: | SHAWNEE MISSION MEDICAL BUILDING | ||||||||
| City: | MERRIAM | ||||||||
| State: | KS | ||||||||
| PostalCode: | 66204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9138942121 | ||||||||
| FaxNumber: | 9138949592 | ||||||||
| Practice Location | |||||||||
| Address1: | 9119 W. 74TH STREET, SUITE 354 | ||||||||
| Address2: | SHAWNEE MISSION MEDICAL BUILDING | ||||||||
| City: | MERRIAM | ||||||||
| State: | KS | ||||||||
| PostalCode: | 66204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9138942121 | ||||||||
| FaxNumber: | 9138949592 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2006 | ||||||||
| LastUpdateDate: | 10/09/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | 15-00862 | KS | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical | 363AS0400X | 2008018557 | MO | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
No ID Information.