Healthcare Provider Details

I. General information

NPI: 1558700559
Provider Name (Legal Business Name): JASON JOSEPH PHILLIPS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2013
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4689 US HIGHWAY 17
FLEMING ISLAND FL
32003-4831
US

IV. Provider business mailing address

4689 US HIGHWAY 17 STE 11-12
FLEMING ISLAND FL
32003-4831
US

V. Phone/Fax

Practice location:
  • Phone: 904-830-0565
  • Fax: 904-830-0565
Mailing address:
  • Phone: 904-830-0565
  • Fax: 904-830-0565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME132392
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: