Individual
NCHANG MANTOH AZEFOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
305 W 15TH ST STE 204, LIBERAL, KS 67901
(620) 624-4946
(620) 624-2260
Mailing address
PO BOX 1215, LIBERAL, KS 67905-1215
(620) 629-3338
(620) 629-6684
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
0440303
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200741890A
—
OK
05
—
201174830A
—
KS
Enumeration date
06/06/2009
Last updated
05/15/2018
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