Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 28072 | AL |
NPI | 1013130186 |
---|---|
Provider Name | Joseph Jason Phillips |
First Address | Dothan, AL 36301-3001 |
Second Address | Dothan, AL 36301-3001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2007 |
Last Update Date | 08/07/2007 |