Provider Demographics
NPI:1013022433
Name:POOR, PHILIP WILLIAMS (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:WILLIAMS
Last Name:POOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 UNIVERSITY AVE
Mailing Address - Street 2:STE 240
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-6524
Mailing Address - Country:US
Mailing Address - Phone:916-923-2600
Mailing Address - Fax:916-646-4036
Practice Address - Street 1:500 UNIVERSITY AVE
Practice Address - Street 2:STE 240
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-6524
Practice Address - Country:US
Practice Address - Phone:916-923-2600
Practice Address - Fax:916-646-4036
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53273207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A532730Medicaid
G24134Medicare UPIN
CA00A532730Medicaid