Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208G00000X | Cardiothoracic Vascular Surgeon | 0101258035 | VA |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 0442249 | KS |
N | 208G00000X | Cardiothoracic Vascular Surgeon | 21559 | SC |
N | 208G00000X | Cardiothoracic Vascular Surgeon | 42638 | KY |
NPI | 1033182290 |
---|---|
Provider Name | Robert A Phillips JR. |
First Address | Hays, KS 67601-2370 |
Second Address | Hays, KS 67601-2370 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2006 |
Last Update Date | 07/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1033182290 | (05) | VA |
215591 | (05) | SC |
A99694 | (02) | SC |