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NPI Code Detail

MEDICARE: PHILLIP PAWSON M.D.

MEDICARE:   PHILLIP  PAWSON  M.D.
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
1208D00000XGeneral Practice Physician036119614IL

General Provider Information

NPI Number : 1245415199
Entity Type Code : Individual
Provider Name (Legal Business Name) : PHILLIP PAWSON M.D.
Provider Business Mailing Address
First Line : 402 PINE ST.
Second Line : PO BOX 135
City : DELAVAN
State : IL
Zip : 61734
Country : US
Telephone Number : 309-244-7669
Fax Number :
Provider Business Practice Location Address
First Line : 402 PINE ST.
Second Line :
City : DELAVAN
State : IL
Zip : 61734
Country : US
Telephone Number : 309-244-7669
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/09/2008
Last Update Date : 10/21/2008

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Directions to “ PHILLIP PAWSON M.D.” Practice Location

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