MEDICARE: PHILLIP THOMAS DOWDLE

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1588231591
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHILLIP THOMAS DOWDLE

Provider Business Mailing Address
First Line	:	1638 OWEN DR
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28304-3424
Country	:	US
Telephone Number	:	910-615-4000
Fax Number	:

Provider Business Practice Location Address
First Line	:	4023 S RALPH ST
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84124-1423
Country	:	US
Telephone Number	:	801-913-3923
Fax Number	:

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

Provider Enumeration Date	:	06/08/2021
Last Update Date	:	05/08/2023

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