Healthcare Provider Details

I. General information

NPI: 1720492242
Provider Name (Legal Business Name): CHRISTOPHER JOHN PHILLIPS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2014
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17021 US HIGHWAY 441
MOUNT DORA FL
32757-6734
US

IV. Provider business mailing address

3324 W UNIVERSITY AVE # 366
GAINESVILLE FL
32607-2540
US

V. Phone/Fax

Practice location:
  • Phone: 352-720-7999
  • Fax:
Mailing address:
  • Phone: 214-941-9200
  • Fax: 409-772-2663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberBP10050704
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR3734
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME137545
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: