MEDICARE: WHITNEY BLAIRE FANCHER 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	207N00000X	Dermatology Physician	04-47805	KS
2	207N00000X	Dermatology Physician	MD177022	OR
3	207ND0101X	MOHS-Micrographic Surgery Physician	MD177022	OR
4	207ND0101X	MOHS-Micrographic Surgery Physician	04-47805	KS

General Provider Information

NPI Number	:	1053699645
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WHITNEY BLAIRE FANCHER M.D.

Provider Business Mailing Address
First Line	:	4110 W 157TH TER
Second Line	:
City	:	OVERLAND PARK
State	:	KS
Zip	:	66224-3529
Country	:	US
Telephone Number	:	417-848-6148
Fax Number	:

Provider Business Practice Location Address
First Line	:	7520 W 160TH ST STE 100
Second Line	:
City	:	OVERLAND PARK
State	:	KS
Zip	:	66085-8137
Country	:	US
Telephone Number	:	913-871-8221
Fax Number	:

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

Provider Enumeration Date	:	07/30/2011
Last Update Date	:	04/12/2026

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