MEDICARE: DR. THEODORE L. PHILLIPS M.D.

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
1	2085R0001X	Radiation Oncology Physician	A19551	CA
2	2085R0202X	Diagnostic Radiology Physician	A19551	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710929963
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THEODORE L. PHILLIPS M.D.

Provider Business Mailing Address
First Line	:	1635 DIVISADERO STREET
Second Line	:	SUITE 625, BOX 1821
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94143-0001
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2701 E ELVIRA RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85756-7124
Country	:	US
Telephone Number	:	520-874-4024
Fax Number	:

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

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	02/07/2012

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