Healthcare Provider Details

I. General information

NPI: 1356343586
Provider Name (Legal Business Name): WILLIAM H PHILLIPS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 03/24/2023
Certification Date: 02/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1371 WEST MAIN STREET
NEWARK OH
43055
US

IV. Provider business mailing address

1371 WEST MAIN STREET
NEWARK OH
43055
US

V. Phone/Fax

Practice location:
  • Phone: 220-564-1965
  • Fax: 220-564-1966
Mailing address:
  • Phone: 220-564-1965
  • Fax: 220-564-1966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number34006522
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number221077
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number34-006522
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: