Provider Demographics
NPI:1497158562
Name:WILLIAMSON, PHILLIP (NMD)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:
Last Name:WILLIAMSON
Suffix:
Gender:M
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22434 N VAN LOO DR
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85138-9393
Mailing Address - Country:US
Mailing Address - Phone:724-944-6520
Mailing Address - Fax:
Practice Address - Street 1:2034 E SOUTHERN AVE STE P
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7519
Practice Address - Country:US
Practice Address - Phone:480-820-5026
Practice Address - Fax:520-333-3206
Is Sole Proprietor?:No
Enumeration Date:2014-10-03
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ14-1446175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath