MEDICARE: DR. PHILLIP WILLIAMSON N.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
1	175F00000X	Naturopath	14-1446	AZ

General Provider Information

NPI Number	:	1497158562
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHILLIP WILLIAMSON N.M.D.

Provider Business Mailing Address
First Line	:	22434 N VAN LOO DR
Second Line	:
City	:	MARICOPA
State	:	AZ
Zip	:	85138-9393
Country	:	US
Telephone Number	:	724-944-6520
Fax Number	:

Provider Business Practice Location Address
First Line	:	2034 E SOUTHERN AVE STE P
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85282-7519
Country	:	US
Telephone Number	:	480-820-5026
Fax Number	:	520-333-3206

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

Provider Enumeration Date	:	10/03/2014
Last Update Date	:	10/07/2014

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