Healthcare Provider Details

I. General information

NPI: 1871055277
Provider Name (Legal Business Name): STEPHEN SCOTT PHILLIPS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2019
Last Update Date: 09/28/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 LOS GAMOS DR
SAN RAFAEL CA
94903-1850
US

IV. Provider business mailing address

1650 LOS GAMOS DR
SAN RAFAEL CA
94903-1850
US

V. Phone/Fax

Practice location:
  • Phone: 415-492-5400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA187902
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: