MEDICARE: DR. BLAKE GORDON PHIPPS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	0441094	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	16289134	OTHER	KS	PTAN
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689084477
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BLAKE GORDON PHIPPS M.D.

Provider Business Mailing Address
First Line	:	4951 W 18TH ST
Second Line	:
City	:	LAWRENCE
State	:	KS
Zip	:	66047-2090
Country	:	US
Telephone Number	:	785-841-6540
Fax Number	:	785-841-3305

Provider Business Practice Location Address
First Line	:	4951 W 18TH ST
Second Line	:
City	:	LAWRENCE
State	:	KS
Zip	:	66047
Country	:	US
Telephone Number	:	785-841-6540
Fax Number	:	785-841-3305

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2014
Last Update Date	:	03/18/2026

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