Provider Demographics
NPI:1043692866
Name:DUHAIME, PHILIPPE (MD)
Entity Type:Individual
Prefix:
First Name:PHILIPPE
Middle Name:
Last Name:DUHAIME
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:COASTAL COMMUNITIES PHYSICIAN NETWORK
Mailing Address - Street 2:1305 MARSH STREET
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401
Mailing Address - Country:US
Mailing Address - Phone:800-763-7732
Mailing Address - Fax:
Practice Address - Street 1:SIERRA VISTA REGIONAL MEDICAL CENTER
Practice Address - Street 2:1010 MURRAY AVE,
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405-9340
Practice Address - Country:US
Practice Address - Phone:805-546-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-29
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA15244207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIVAD000Medicare UPIN