MEDICARE: MARK G PHILLIPS MD

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	ME55124	FL

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	220011725	OTHER		RAILROAD MEDICARE

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	14419	OTHER	FL	BLUE CROSS BLUE SHIELD

NPI Number	:	1063494375
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK G PHILLIPS MD

Provider Business Mailing Address
First Line	:	300 BUTLER ST
Second Line	:	PALM BEACH PATHOLOGY PA
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-6006
Country	:	US
Telephone Number	:	561-659-0770
Fax Number	:	561-802-3504

Provider Business Practice Location Address
First Line	:	2013 PONCE DELEON AVE
Second Line	:	PALM BEACH PATHOLOGY PA
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-6019
Country	:	US
Telephone Number	:	561-659-0770
Fax Number	:	561-802-3504

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/14/2005
Last Update Date	:	08/27/2010

2101 E JEFFERSON ST PPQA MEDICARE COMPLIANCE UNT 6 WEST , KAISER PERMANENTE MID ATLANTIC PERMANENTE MEDICAL GROUP
ROCKVILLE, MD
20852-4908

Practice Phone: 301-816-6660
Practice Fax: 301-816-6308

2013 PONCE DE LEON AVE
WEST PALM BEACH, FL
33407-6019