Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 18-1717 | AZ |
NPI | 1033697073 |
---|---|
Provider Name | Dr. Mark Phillips |
First Address | Gilbert, AZ 85234-2340 |
Second Address | Gilbert, AZ 85234-2340 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2018 |
Last Update Date | 01/08/2018 |