Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 125.075365 | IL |
NPI | 1013413731 |
---|---|
Provider Name | Alexandra Jordan Douglas Phelps |
First Address | Pittsburgh, PA 15212-4772 |
Second Address | Park Ridge, IL 60068-1186 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2018 |
Last Update Date | 03/02/2020 |