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General NPI Number Information
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NPI Number | 1275554669
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Entity Type | Individual
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Provider Name | BRADFORD G. PHILLIPS PA-C
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Gender | Male
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Dates
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Enumeration Date | 07/21/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 431 FRANKLIN ST
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City | RUMFORD
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State | ME
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Zip | 04276-2100
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Country | US
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Telephone | 207-369-3200
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Fax |
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Provider Business Mailing Address
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Address Line | 580 CURTIS HILL RD
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City | BRYANT POND
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State | ME
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Zip | 04219-6538
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Country | US
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Telephone | 207-674-3862
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA 132
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License Number State | ME
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