Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 19522 | NE |
NPI | 1033150610 |
---|---|
Provider Name | Samuel P Phillips |
First Address | Omaha, NE 68130-2396 |
Second Address | Omaha, NE 68124-2372 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2006 |
Last Update Date | 08/06/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1576975 | (05) | IA |
30680 | BCBS NEBRASKA (01) | NE |
47063010113 | (05) | NE |
F56473 | (02) | NE |