Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2081S0010X | Sports Medicine | 2005012032 | MO |
N | 213ES0000X | Sports Medicine | 2005012032 | MO |
N | 2081S0010X | Sports Medicine | KS 12-00349 | KS |
N | 213ES0000X | Sports Medicine | KS 12-00349 | KS |
Y | 213ES0131X | Foot Surgery | 12-00349 | KS |
N | 213ES0131X | Foot Surgery | 2005012032 | MO |
NPI | 1154363703 |
---|---|
Provider Name | Timothy Bryan Gateley |
First Address | Topeka, KS 66606-1581 |
Second Address | Topeka, KS 66614-5318 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2006 |
Last Update Date | 04/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
V04957 | (02) | KS |