Provider Demographics
NPI:1033531439
Name:DR. ROY PHILLIPS
Entity Type:Organization
Organization Name:DR. ROY PHILLIPS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:858-272-1091
Mailing Address - Street 1:3670 CLAIREMONT DR
Mailing Address - Street 2:#7
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-5911
Mailing Address - Country:US
Mailing Address - Phone:858-272-1091
Mailing Address - Fax:866-401-4918
Practice Address - Street 1:3670 CLAIREMONT DR
Practice Address - Street 2:SUITE #7
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-5911
Practice Address - Country:US
Practice Address - Phone:858-272-1091
Practice Address - Fax:866-401-4918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-20
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE1394213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1104832070OtherNPI
CA1104832070OtherNPI
CAT10934Medicare UPIN