Basic Information
| Provider Information | |||||||||
| NPI: | 1912019274 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SEYMOUR | ||||||||
| FirstName: | GALEN | ||||||||
| MiddleName: | L | ||||||||
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| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 3550 S 4TH ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | LEAVENWORTH | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660485009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9136806442 | ||||||||
| FaxNumber: | 9133511346 | ||||||||
| Practice Location | |||||||||
| Address1: | 3550 S 4TH ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | LEAVENWORTH | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660485009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9136806442 | ||||||||
| FaxNumber: | 9133511346 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 12/03/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 12/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 0431830 | KS | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000212 | 01 | KS | BLUE CROSS | OTHER | 100069780F | 05 | KS | MEDICAID | 100099480A | 05 | KS | MEDICAID |