Provider Demographics
NPI:1033697073
Name:PHILLIPS, MARK (NMD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1170 N GILBERT RD STE 15
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-2340
Mailing Address - Country:US
Mailing Address - Phone:480-834-4187
Mailing Address - Fax:
Practice Address - Street 1:1170 N GILBERT RD STE 15
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2340
Practice Address - Country:US
Practice Address - Phone:480-834-4187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ18-1717175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath