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General NPI Number Information
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NPI Number | 1710238449
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Entity Type | Organization
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Legal Business Name | LLEWELLYN PHILLIPS II M.D., INC., P.S.
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Dates
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Enumeration Date | 09/20/2012
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Last Update Date | 09/20/2012
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Provider Practice Location Address
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Address Line | 4509 TALBOT RD S SUITE 200
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City | RENTON
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State | WA
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Zip | 98055-6294
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Country | US
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Telephone | 425-228-4520
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Fax | 425-226-0283
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Provider Business Mailing Address
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Address Line | 4509 TALBOT RD S SUITE 200
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City | RENTON
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State | WA
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Zip | 98055-6294
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Country | US
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Telephone | 425-228-4520
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Fax | 425-226-0283
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LLEWELLYN PHILLIPS II
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Credential | M.D.
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Telephone | 425-228-4900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | MD00013579
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License Number State | WA
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