Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 25MA10397400 | NJ |
N | 207QS0010X | Family Doctor - Sports Medicine | ME110737 | FL |
NPI | 1205090974 |
---|---|
Provider Name | Dr. Jonathan Winston Phillips |
First Address | Oviedo, FL 32765-6591 |
Second Address | Norwood, NJ 07648-2001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2008 |
Last Update Date | 18/11/2020 |