Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | ME64639 | FL |
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | ME64639 | FL |
NPI | 1518937689 |
---|---|
Provider Name | Jonathan H. Phillips |
First Address | Orlando, FL 32806-1215 |
Second Address | Orlando, FL 32806-1215 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2006 |
Last Update Date | 10/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
374268700 | (05) | FL |
ME64639 | MEDICAL LICENSE (01) | FL |