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General NPI Number Information
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NPI Number | 1295116242
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Entity Type | Individual
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Provider Name | PHILIP LODGE AMES M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/16/2015
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Last Update Date | 11/30/2021
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Provider Practice Location Address
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Address Line | 217 MANATEE AVE E
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City | BRADENTON
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State | FL
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Zip | 34208-1931
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Country | US
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Telephone | 941-748-1818
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Fax | 941-746-1055
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Provider Business Mailing Address
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Address Line | 217 MANATEE AVE E
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City | BRADENTON
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State | FL
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Zip | 34208-1931
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Country | US
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Telephone | 941-748-1818
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Fax | 941-746-1055
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 26687
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 58966
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License Number State | TN
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