Provider Demographics
NPI:1285683805
Name:PHILLIPS, ROBERT RAYMOND (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:RAYMOND
Last Name:PHILLIPS
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:PO BOX 6369
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59604-6369
Mailing Address - Country:US
Mailing Address - Phone:406-447-2828
Mailing Address - Fax:
Practice Address - Street 1:2550 E BROADWAY ST
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601
Practice Address - Country:US
Practice Address - Phone:406-457-4180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00035268207R00000X, 207RC0000X
MT36103207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5486PHOtherREGENCE BLUE SHIELD
AKMD1868Medicaid
WA7870297OtherAETNA
WA82107OtherL&I AND CRIME VICTIMS FOR SJMC
WA8358863Medicaid
WAG010OtherTRI WEST (TRICARE)
WA1285683805Medicaid
WAP00049744OtherRAILROAD MEDICARE
WA0279978OtherL&I AND CRIME VICTIMS FOR PHMG
WA8358863Medicaid
WAG8900419Medicare PIN
WAP00049744OtherRAILROAD MEDICARE
WAH48202Medicare UPIN
WA1285683805Medicaid