Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | G52065 | CA |
N | 208600000X | Surgeon | G52065 | CA |
Y | 2086X0206X | Surgical Oncologist | G52065 | CA |
NPI | 1033180682 |
---|---|
Provider Name | Vicki J Philben |
First Address | Fort Myers, FL 33907-1412 |
Second Address | Redding, CA 96002-1800 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2006 |
Last Update Date | 12/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G520650 | BLUE SHIELD (01) | CA |
00G520651 | (05) | CA |
3187177 | CIGNA (01) | CA |
5318419 | AETNA (01) | CA |
A03128 | (02) | CA |
P00977722 | RAILROAD MEDICARE (01) | CA |