Provider Demographics
NPI:1053348979
Name:PHIPPS, WILLIAM REVELLE (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:REVELLE
Last Name:PHIPPS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12200 W 106TH ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66215-2305
Mailing Address - Country:US
Mailing Address - Phone:913-894-2323
Mailing Address - Fax:913-894-0841
Practice Address - Street 1:12200 W 106TH ST
Practice Address - Street 2:SUITE 120
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66215-2305
Practice Address - Country:US
Practice Address - Phone:913-894-2323
Practice Address - Fax:913-894-0841
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-38170207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4418300OtherAETNA
NYMD428POtherPREFERRED CARE
NYP010187220OtherBLUE CHOICE
NY01262853Medicaid
NY2075OtherBLUE SHIELD
NYB76448Medicare UPIN
NY33936EMedicare ID - Type Unspecified