Provider Demographics
NPI:1144754953
Name:ESPARZA, GREGORY A (MD, PHD)
Entity type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:A
Last Name:ESPARZA
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 937
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:KS
Mailing Address - Zip Code:67950-0937
Mailing Address - Country:US
Mailing Address - Phone:620-697-2141
Mailing Address - Fax:
Practice Address - Street 1:445 HILLTOP STREET
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:KS
Practice Address - Zip Code:67950-6795
Practice Address - Country:US
Practice Address - Phone:620-697-2141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-18
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-46237207P00000X
KS0446237207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine