Healthcare Provider Details

I. General information

NPI: 1194971994
Provider Name (Legal Business Name): JILLIAN FRANKLIN PHELPS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2008
Last Update Date: 03/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MADIGAN ARMY MEDICAL CENTER 9040A JACKSON AVENUE
TACOMA WA
98431
US

IV. Provider business mailing address

MADIGAN ARMY MEDICAL CENTER 9040A JACKSON AVENUE
TACOMA WA
98431
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-0597
  • Fax:
Mailing address:
  • Phone: 253-968-0597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD60514769
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0101246182
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: