Provider Demographics
NPI:1033180682
Name:PHILBEN, VICKI J (MD)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:J
Last Name:PHILBEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:310 HARTNELL AVE
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-1800
Practice Address - Country:US
Practice Address - Phone:530-244-2223
Practice Address - Fax:530-244-4799
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG52065208600000X, 2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00977722OtherRAILROAD MEDICARE
CA00G520650OtherBLUE SHIELD
CA3187177OtherCIGNA
CA00G520651Medicaid
CA5318419OtherAETNA
CACC548YMedicare PIN
CA00G520650Medicare PIN
CA00G520650OtherBLUE SHIELD
CAP00977722OtherRAILROAD MEDICARE