Healthcare Provider Details

I. General information

NPI: 1285747857
Provider Name (Legal Business Name): GEORGE H PHILLIPS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 06/23/2020
Certification Date: 06/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 ROCKY MOUNTAIN AVE STE 2200
LOVELAND CO
80538-9004
US

IV. Provider business mailing address

2500 ROCKY MOUNTAIN AVE STE 2200
LOVELAND CO
80538-9004
US

V. Phone/Fax

Practice location:
  • Phone: 970-669-9100
  • Fax: 970-669-0400
Mailing address:
  • Phone: 970-669-9100
  • Fax: 970-669-0400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number28760
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: