Provider Demographics
NPI:1508802893
Name:PEGG, PHILLIP O JR (PHD)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:O
Last Name:PEGG
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:PHILLIP
Other - Middle Name:O
Other - Last Name:PEGG
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:2790 CLAY EDWARDS DR STE 1250
Mailing Address - Street 2:C/O HELLMAN & ROSEN ENDOCRINE
Mailing Address - City:NORTH KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116-3260
Mailing Address - Country:US
Mailing Address - Phone:816-421-3700
Mailing Address - Fax:816-421-1654
Practice Address - Street 1:2790 CLAY EDWARDS DR STE 1250
Practice Address - Street 2:C/O HELLMAN & ROSEN ENDOCRINE
Practice Address - City:NORTH KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-3260
Practice Address - Country:US
Practice Address - Phone:816-421-3700
Practice Address - Fax:816-421-1654
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1390101YM0800X
MOPYT0122103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP01644526OtherRAILROAD MEDICARE
MO402000023Medicare PIN