Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 94-10216 | KS |
NPI | 1003439605 |
---|---|
Provider Name | James Phillips |
First Address | Wichita, KS 67214-3124 |
Second Address | Wichita, KS 67214-3124 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2020 |
Last Update Date | 19/05/2020 |