Individual
DR. BLAKE GORDON PHIPPS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4951 W 18TH ST, LAWRENCE, KS 66047
(785) 841-6540
(785) 841-3305
Mailing address
4951 W 18TH ST, LAWRENCE, KS 66047-2090
(785) 841-6540
(785) 841-3305
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0441094
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
16289134
PTAN
KS
05
—
200155510
—
MO
05
—
201205020A
—
KS
05
—
30004601610001
—
KS
Enumeration date
05/01/2014
Last updated
03/18/2026
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