Healthcare Provider Details

I. General information

NPI: 1891809240
Provider Name (Legal Business Name): COREY D PHILPOT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 06/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3006 S MARYLAND PKWY STE 510
LAS VEGAS NV
89109-2224
US

IV. Provider business mailing address

3006 S MARYLAND PKWY STE 510
LAS VEGAS NV
89109-2224
US

V. Phone/Fax

Practice location:
  • Phone: 702-697-5234
  • Fax:
Mailing address:
  • Phone: 702-697-5234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number13176
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD00047905
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberMD00047905
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: