Healthcare Provider Details

I. General information

NPI: 1053348979
Provider Name (Legal Business Name): WILLIAM REVELLE PHIPPS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 10/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12200 W 106TH ST SUITE 120
OVERLAND PARK KS
66215-2305
US

IV. Provider business mailing address

12200 W 106TH ST SUITE 120
OVERLAND PARK KS
66215-2305
US

V. Phone/Fax

Practice location:
  • Phone: 913-894-2323
  • Fax: 913-894-0841
Mailing address:
  • Phone: 913-894-2323
  • Fax: 913-894-0841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number04-38170
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: