Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VE0102X | Reproductive Endocrinologist | 04-38170 | KS |
NPI | 1053348979 |
---|---|
Provider Name | Dr. William Revelle Phipps |
First Address | Overland Park, KS 66215-2305 |
Second Address | Overland Park, KS 66215-2305 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2006 |
Last Update Date | 13/10/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01262853 | (05) | NY |
2075 | BLUE SHIELD (01) | NY |
4418300 | AETNA (01) | NY |
B76448 | (02) | NY |
MD428P | PREFERRED CARE (01) | NY |
P010187220 | BLUE CHOICE (01) | NY |