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General NPI Number Information
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NPI Number | 1851564462
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Entity Type | Individual
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Provider Name | PETER PHAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/04/2008
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Last Update Date | 11/25/2025
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Provider Practice Location Address
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Address Line | 305 W 15TH ST STE 204
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City | LIBERAL
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State | KS
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Zip | 67901-2455
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Country | US
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Telephone | 620-624-4946
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Fax | 620-624-2260
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Provider Business Mailing Address
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Address Line | 305 W 15TH ST STE 204
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City | LIBERAL
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State | KS
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Zip | 67901-2455
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Country | US
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Telephone | 620-629-6739
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Fax | 620-629-6523
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 0438080
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License Number State | KS
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