Provider Demographics
NPI:1275597999
Name:EBERSOLE, PHILIP MURPHY (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:MURPHY
Last Name:EBERSOLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:30650 RANCHO CALIFORNIA RD STE D406-145
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-3215
Mailing Address - Country:US
Mailing Address - Phone:951-894-6868
Mailing Address - Fax:951-894-6860
Practice Address - Street 1:25405 HANCOCK AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-5982
Practice Address - Country:US
Practice Address - Phone:951-894-6868
Practice Address - Fax:951-894-6860
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC43172207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C431720Medicare ID - Type Unspecified
CAB22449Medicare UPIN