Healthcare Provider Details

I. General information

NPI: 1891706867
Provider Name (Legal Business Name): CHRISTOPHER E PHILLIPS PAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 04/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4235 SECOR RD
TOLEDO OH
43623-4231
US

IV. Provider business mailing address

4235 SECOR RD
TOLEDO OH
43623
US

V. Phone/Fax

Practice location:
  • Phone: 419-479-5820
  • Fax: 419-479-5821
Mailing address:
  • Phone: 419-479-5820
  • Fax: 440-988-1225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50002339
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2339
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: