Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | ME118856 | FL |
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | ME118856 | FL |
NPI | 1619130473 |
---|---|
Provider Name | Jeffrey M Phillips |
First Address | Gainesville, FL 32607-2557 |
Second Address | Gainesville, FL 32607-2557 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2008 |
Last Update Date | 16/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
14V77 | BCBS (01) | FL |
O12922400 | (05) | FL |