=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508398827
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALEXSANDRA MARIA GREER PHILLIPS MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/28/2017
-----------------------------------------------------
Last Update Date | 03/22/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 357 NW RICHMOND BEACH RD
-----------------------------------------------------
City | SHORELINE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98177-3101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-987-2525
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9505 S STEELE ST
-----------------------------------------------------
City | TACOMA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98444-6858
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-597-6800
-----------------------------------------------------
Fax | 253-597-6888
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | MD61039211
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------