Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 264285 | MA |
N | 207YP0228X | Pediatric Otolaryngology | 11273467-1205 | UT |
N | 208200000X | Surgeon | 37240 | SC |
N | 208600000X | Surgeon | 37240 | SC |
NPI | 1285049510 |
---|---|
Provider Name | Dr. Philip Ryan Molarte Camilon |
First Address | Salt Lake City, UT 84132-0001 |
Second Address | Orange, CA 92868-4547 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2014 |
Last Update Date | 05/06/2020 |