Provider Demographics
NPI:1326082959
Name:POHORECKI, ROMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ROMAN
Middle Name:
Last Name:POHORECKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 739
Mailing Address - Street 2:
Mailing Address - City:LIBERAL
Mailing Address - State:KS
Mailing Address - Zip Code:67905-0739
Mailing Address - Country:US
Mailing Address - Phone:620-624-1550
Mailing Address - Fax:620-624-2545
Practice Address - Street 1:15TH AT PERSHING
Practice Address - Street 2:
Practice Address - City:LIBERAL
Practice Address - State:KS
Practice Address - Zip Code:67901-2455
Practice Address - Country:US
Practice Address - Phone:620-624-1651
Practice Address - Fax:620-629-6655
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-27483207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS101423OtherBLUE CROSS
KS101423Medicare ID - Type Unspecified
KSE93030Medicare UPIN