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General NPI Number Information
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NPI Number | 1962491118
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Entity Type | Individual
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Provider Name | DEAN JAMES PHILLIPS DO
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Gender | Male
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Dates
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Enumeration Date | 10/20/2005
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Last Update Date | 01/22/2024
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Provider Practice Location Address
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Address Line | 741 SAN RAPHAEL ST
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City | KISSIMMEE
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State | FL
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Zip | 34759-3909
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Country | US
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Telephone | 315-778-1373
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Fax | 315-786-5058
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Provider Business Mailing Address
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Address Line | 741 SAN RAPHAEL ST
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City | KISSIMMEE
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State | FL
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Zip | 34759-3909
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Country | US
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Telephone | 315-778-1373
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 0102201536
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | DO883
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 200401304
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License Number State | NC
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Taxonomy #4
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | OS9121
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License Number State | FL
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Taxonomy #5
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 189847-1
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License Number State | NY
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