Provider Demographics
NPI:1235526989
Name:PHILLIPS, JACOB WILLIAM (DO)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:WILLIAM
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 MCCORMICK DR STE 180
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-5345
Mailing Address - Country:US
Mailing Address - Phone:301-883-0866
Mailing Address - Fax:
Practice Address - Street 1:1801 MCCORMICK DR STE 180
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-5345
Practice Address - Country:US
Practice Address - Phone:301-883-0866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-21
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0089766207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine