Provider Demographics
NPI:1437155231
Name:PHILLIPS, RAYMOND W (MD)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:W
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 1:685 LISMORE LN
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34108-8562
Mailing Address - Country:US
Mailing Address - Phone:239-649-1186
Mailing Address - Fax:239-649-1156
Practice Address - Street 1:1064 GOODLETTE RD N
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5449
Practice Address - Country:US
Practice Address - Phone:239-649-1186
Practice Address - Fax:239-649-1156
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME59041174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL054684400Medicaid
FLE84539Medicare UPIN
FL12214YMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER