Healthcare Provider Details

I. General information

NPI: 1790793347
Provider Name (Legal Business Name): PAUL R PHELPS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 02/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25500 MEDICAL CENTER DR
MURRIETA CA
92562-5965
US

IV. Provider business mailing address

25470 MEDICAL CENTER DR 206
MURRIETA CA
92562-4900
US

V. Phone/Fax

Practice location:
  • Phone: 951-973-7380
  • Fax: 951-973-7389
Mailing address:
  • Phone: 951-973-7380
  • Fax: 951-973-7389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberG57719
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: