Individual
NATHANIEL M PHELAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
520 E 32ND ST, JOPLIN, MO 64804-3904
(417) 622-0293
(833) 275-1784
Mailing address
520 E 32ND ST, JOPLIN, MO 64804-3904
(417) 622-0293
(833) 275-1784
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
2018014111
MO
207ND0101X
MOHS-Micrographic Surgery Physician
2018014111
MO
207NS0135X
Procedural Dermatology Physician
2018014111
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2018014111
DERMATOLOGY
MO
Enumeration date
03/29/2011
Last updated
12/27/2024
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