Provider Demographics
NPI:1700148442
Name:LIBERAL FAMILY MEDICINE, LLC
Entity Type:Organization
Organization Name:LIBERAL FAMILY MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANCISCO
Authorized Official - Middle Name:J
Authorized Official - Last Name:CHACON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:620-604-9698
Mailing Address - Street 1:305 W 15TH ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LIBERAL
Mailing Address - State:KS
Mailing Address - Zip Code:67901
Mailing Address - Country:US
Mailing Address - Phone:620-604-9698
Mailing Address - Fax:
Practice Address - Street 1:305 W 15TH ST
Practice Address - Street 2:SUITE 103
Practice Address - City:LIBERAL
Practice Address - State:KS
Practice Address - Zip Code:67901
Practice Address - Country:US
Practice Address - Phone:620-604-9698
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-08
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-33980207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty