MEDICARE: DR. PHILLIP BLAINE LEY 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	2086X0206X	Surgical Oncology Physician	14786	MS

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	:	1790890499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHILLIP BLAINE LEY M.D.

Provider Business Mailing Address
First Line	:	PO BOX 321359
Second Line	:
City	:	FLOWOOD
State	:	MS
Zip	:	39232-1359
Country	:	US
Telephone Number	:	601-936-1395
Fax Number	:	601-933-6596

Provider Business Practice Location Address
First Line	:	1020 N FLOWOOD DR STE A
Second Line	:
City	:	FLOWOOD
State	:	MS
Zip	:	39232-9532
Country	:	US
Telephone Number	:	601-933-6132
Fax Number	:

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

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	08/19/2020

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