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NPI Code Detail

MEDICARE: DR. PHILLIP O PEGG JR. PH.D

MEDICARE: DR. PHILLIP O PEGG JR. PH.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
1101YM0800XMental Health Counselor1390KY
2103TC0700XClinical PsychologistPYT0122MO

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P01644526OTHERMORAILROAD MEDICARE

General Provider Information

NPI Number : 1508802893
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PHILLIP O PEGG JR. PH.D
Provider Business Mailing Address
First Line : 2790 CLAY EDWARDS DR STE 1250
Second Line : C/O HELLMAN & ROSEN ENDOCRINE
City : NORTH KANSAS CITY
State : MO
Zip : 64116-3260
Country : US
Telephone Number : 816-421-3700
Fax Number : 816-421-1654
Provider Business Practice Location Address
First Line : 2790 CLAY EDWARDS DR STE 1250
Second Line : C/O HELLMAN & ROSEN ENDOCRINE
City : NORTH KANSAS CITY
State : MO
Zip : 64116-3260
Country : US
Telephone Number : 816-421-3700
Fax Number : 816-421-1654
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/22/2006
Last Update Date : 06/10/2016

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Practice Location Address:
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Practice Fax: 816-421-1654

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