MEDICARE: DR. PAUL KENNETH PHILLIPS 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	2084P0800X	Psychiatry Physician	01056981A	IN
2	2084P0800X	Psychiatry Physician	ME117663	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427051937
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL KENNETH PHILLIPS MD

Provider Business Mailing Address
First Line	:	1940 HARRISON AVE
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-4542
Country	:	US
Telephone Number	:	850-763-0017
Fax Number	:	850-532-6454

Provider Business Practice Location Address
First Line	:	1940 HARRISON AVE
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-4542
Country	:	US
Telephone Number	:	850-763-0017
Fax Number	:	850-532-6454

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

Provider Enumeration Date	:	05/30/2005
Last Update Date	:	04/24/2018

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