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General NPI Number Information
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NPI Number | 1285965657
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Entity Type | Individual
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Provider Name | PHILIP FRED MICHAEL M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/24/2010
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 2825 E BARNETT RD
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City | MEDFORD
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State | OR
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Zip | 97504-8332
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Country | US
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Telephone | 541-789-2558
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Fax | 541-789-2558
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Provider Business Mailing Address
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Address Line | 691 MURPHY RD STE 218
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City | MEDFORD
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State | OR
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Zip | 97504-4311
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Country | US
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Telephone | 541-789-6145
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Fax | 541-789-3037
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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 | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | G51239
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD183405
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License Number State | OR
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