Healthcare Provider Details

I. General information

NPI: 1134509243
Provider Name (Legal Business Name): MILBURN WHEATLEY HOBSON M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2015
Last Update Date: 06/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RESIDENCE 5467 W. 85 TER.
PRAIRIE VILLAGE KS
66207
US

IV. Provider business mailing address

RESIDENCE 5467 W. 85TH TER.
PRAIRIE VILLAGE KS
66207
US

V. Phone/Fax

Practice location:
  • Phone: 913-381-1387
  • Fax:
Mailing address:
  • Phone: 913-381-1387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number04-10879
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: