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General NPI Number Information
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NPI Number | 1548623002
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Entity Type | Individual
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Provider Name | PHILLIP JOHN GARY MD
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Gender | Male
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Dates
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Enumeration Date | 04/01/2016
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Last Update Date | 01/19/2024
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Provider Practice Location Address
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Address Line | 90 PRESIDENTIAL PLAZA 2ND FL
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City | SYRACUSE
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State | NY
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Zip | 13202
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Country | US
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Telephone | 315-464-3835
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Fax | 315-464-3837
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Provider Business Mailing Address
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Address Line | 90 PRESIDENTIAL PLAZA 2ND FL
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City | SYRACUSE
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State | NY
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Zip | 13202
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Country | US
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Telephone | 315-464-3835
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Fax | 315-464-3837
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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 | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | 321739
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 67353
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 312739
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License Number State | NY
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