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General NPI Number Information
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NPI Number | 1295423200
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Entity Type | Individual
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Provider Name | JEREL ANTONIO PHILLIPS MD
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Gender | Male
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Dates
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Enumeration Date | 04/27/2023
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Last Update Date | 10/30/2023
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Provider Practice Location Address
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Address Line | MARTINDALE'S ROAD
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City | ST MICHAEL
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State | BRIDGETOWN
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Zip | 11155
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Country | BB
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Telephone | 246-436-6450
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Fax |
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Provider Business Mailing Address
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Address Line | #8 LOWLANDS
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City | ST LUCY
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State | BRIDGETOWN
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Zip | 27089
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Country | BB
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Telephone |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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