Provider Demographics
NPI:1093731002
Name:PHILLIPS, DELANA JEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:DELANA
Middle Name:JEAN
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DELANA
Other - Middle Name:PHILLIPS
Other - Last Name:WHITED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:P.O. BOX 2508
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96745-2508
Mailing Address - Country:US
Mailing Address - Phone:850-474-8100
Mailing Address - Fax:850-474-8083
Practice Address - Street 1:77-311 SUNSET DR
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-9754
Practice Address - Country:US
Practice Address - Phone:850-474-8100
Practice Address - Fax:850-474-8083
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG56304207Q00000X
HIMD8224207Q00000X
NC9600229207Q00000X
FLME 96370207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
080167875OtherRAILROAD MEDICARE
603011900OtherFEDERAL WORKERS COMP
NC67565OtherBCBS
NC891192EMedicaid
C2730OtherMED COST
562174647001OtherTRICARE
C2730OtherMED COST
2250207CMedicare PIN