Provider Demographics
NPI:1134310915
Name:PHILIP D WILEY MD PC
Entity Type:Organization
Organization Name:PHILIP D WILEY MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:WILEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-247-2920
Mailing Address - Street 1:1165 S COMINO DEL RIO # 200
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81303-6824
Mailing Address - Country:US
Mailing Address - Phone:970-247-2920
Mailing Address - Fax:970-247-2923
Practice Address - Street 1:1165 S COMINO DEL RIO # 200
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81303-6824
Practice Address - Country:US
Practice Address - Phone:970-247-2920
Practice Address - Fax:970-247-2923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-06
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO35193207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCN3008Medicare PIN