Provider Demographics
NPI:1881616282
Name:PHELPS, ANGELA MICHELLE (MD)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:MICHELLE
Last Name:PHELPS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 E RUSSELL AVE BLDG C
Mailing Address - Street 2:
Mailing Address - City:WARRENSBURG
Mailing Address - State:MO
Mailing Address - Zip Code:64093-1242
Mailing Address - Country:US
Mailing Address - Phone:660-747-5114
Mailing Address - Fax:660-747-5684
Practice Address - Street 1:407 E RUSSELL AVE BLDG C
Practice Address - Street 2:
Practice Address - City:WARRENSBURG
Practice Address - State:MO
Practice Address - Zip Code:64093-1242
Practice Address - Country:US
Practice Address - Phone:660-747-5114
Practice Address - Fax:660-747-5684
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001014668207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO7664602OtherAETNA
MO11127872OtherCAQH
MOT14C603Medicare ID - Type UnspecifiedMEDICARE
MO11127872OtherCAQH