Provider Demographics
NPI:1073566600
Name:PHILLIPS, JAMES R (DO)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:18695 W 151ST ST
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-2738
Mailing Address - Country:US
Mailing Address - Phone:913-782-3322
Mailing Address - Fax:913-782-1264
Practice Address - Street 1:18695 W 151ST ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-2738
Practice Address - Country:US
Practice Address - Phone:913-782-3322
Practice Address - Fax:913-782-1264
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0523482207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100145190AMedicaid
E74434Medicare UPIN
KS0332131DMedicare PIN