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General NPI Number Information
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NPI Number | 1245533207
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Entity Type | Organization
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Legal Business Name | MARYANNE D. PHILLIPS MD APC
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Dates
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Enumeration Date | 12/14/2010
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Last Update Date | 12/14/2010
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Provider Practice Location Address
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Address Line | 7835 S RAINBOW BL STE 15
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City | LAS VEGAS
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State | NV
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Zip | 89139
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Country | US
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Telephone | 702-860-8965
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Fax |
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Provider Business Mailing Address
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Address Line | 10600 SOUTHERN HIGHLANDS PKWY
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City | LAS VEGAS
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State | NV
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Zip | 89141-4368
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Country | US
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Telephone | 702-860-8965
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARYANNE D PHILLIPS
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Credential | M.D.
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Telephone | 702-860-8965
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | A63753
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License Number State | CA
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