MEDICARE: DR. COREY D PHILPOT MD

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	2080P0203X	Pediatric Critical Care Medicine Physician	13176	NV
2	207L00000X	Anesthesiology Physician	MD00047905	WA
3	2080P0203X	Pediatric Critical Care Medicine Physician	MD00047905	WA

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891809240
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. COREY D PHILPOT MD

Provider Business Mailing Address
First Line	:	3006 S MARYLAND PKWY STE 510
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89109-2224
Country	:	US
Telephone Number	:	702-697-5234
Fax Number	:

Provider Business Practice Location Address
First Line	:	3006 S MARYLAND PKWY STE 510
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89109-2224
Country	:	US
Telephone Number	:	702-697-5234
Fax Number	:

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

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	06/08/2011

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