MEDICARE: DR. PHILIP A DAUTERMAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	M-1177	GU
2	207ZP0105X	Clinical Pathology/Laboratory Medicine Physician	M-1177	GU

General Provider Information

NPI Number	:	1225094055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHILIP A DAUTERMAN MD

Provider Business Mailing Address
First Line	:	1 LOWER NAVY HILL ROAD
Second Line	:
City	:	SAIPAN
State	:	MP
Zip	:	96950
Country	:	US
Telephone Number	:	670-234-8950
Fax Number	:	670-236-8612

Provider Business Practice Location Address
First Line	:	1 LOWER NAVY HILL ROAD
Second Line	:
City	:	SAIPAN
State	:	MP
Zip	:	96950
Country	:	US
Telephone Number	:	670-234-8950
Fax Number	:	670-236-8612

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/21/2006
Last Update Date	:	09/07/2016

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