Provider Demographics
NPI:1124020904
Name:PHILIP, JEFFREY (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:PHILIP
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 1:200 NORTHLAND BOULEVARD
Mailing Address - Street 2:OUTPATIENT ANESTHESIA SPECIALISTS
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45246
Mailing Address - Country:US
Mailing Address - Phone:513-204-5696
Mailing Address - Fax:877-284-4283
Practice Address - Street 1:2000 JOSEPH E. SANKER BOULEVARD
Practice Address - Street 2:THE UROLOGY CENTER
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45212
Practice Address - Country:US
Practice Address - Phone:513-841-7600
Practice Address - Fax:513-841-7601
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35065050207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0964425Medicaid
F73603Medicare UPIN
OHPH0755242Medicare ID - Type Unspecified