Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | MD177180 | OR |
Y | 208600000X | Surgeon | MD177180 | OR |
N | 208200000X | Surgeon | ML20009072 | WA |
N | 208600000X | Surgeon | ML20009072 | WA |
N | 2086S0129X | Vascular Surgeon | MD177180 | OR |
NPI | 1144412529 |
---|---|
Provider Name | Patrick Joseph Phelan |
First Address | Medford, OR 97504-4316 |
Second Address | Medford, OR 97504-4316 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2007 |
Last Update Date | 02/09/2016 |