Healthcare Provider Details

I. General information

NPI: 1124160296
Provider Name (Legal Business Name): JOHN MARTIN PHILLIPS II M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 05/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 BRECKENRIDGE ST STE 300
OWENSBORO KY
42303-0877
US

IV. Provider business mailing address

PO BOX 23229
OWENSBORO KY
42304-3229
US

V. Phone/Fax

Practice location:
  • Phone: 270-688-4480
  • Fax: 270-688-4489
Mailing address:
  • Phone: 270-688-1330
  • Fax: 270-688-1338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number42304
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: