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NPI Code Detail

MEDICARE: MARK PHILLIPS

MEDICARE: MARK PHILLIPS
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantPA17702CA

General Provider Information

NPI Number : 1114167814
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK PHILLIPS
Provider Business Mailing Address
First Line : 1335 STANFORD AVE
Second Line :
City : EMERYVILLE
State : CA
Zip : 94608-2536
Country : US
Telephone Number : 510-647-5101
Fax Number :
Provider Business Practice Location Address
First Line : 1335 STANFORD AVE
Second Line :
City : EMERYVILLE
State : CA
Zip : 94608-2536
Country : US
Telephone Number : 510-647-5101
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/20/2009
Last Update Date : 04/03/2013

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Directions to “ MARK PHILLIPS ” Practice Location

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