Doctor Name: | MR. EDWIN LYSLE PRICE |
NPI Number: | 1124129911 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | RPAC |
License Number: | 15-00248 |
Business Practice Address: | 606 Mulberry Rd Derby, KS - 670373532 |
Business Phone Number: | 3167883787 |
Business Fax Number: | 3167886930 |
Mailing Address: | 1725 Tiara Pines Dr, DERBY |
State: | KS |
Postal Code: | 670373933 |
Phone Number: | 3167885369 |
Fax Number: | |
NPI Enumeration Date: | 09/26/2006 |
NPI Last Update Date: | 07/19/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 15-00248 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | KS |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |