Provider Demographics
NPI:1497723266
Name:PHILLIPS, JOHN WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WILLIAM
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1223 S GEAR AVE
Mailing Address - Street 2:STE 202
Mailing Address - City:WEST BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52655-1685
Mailing Address - Country:US
Mailing Address - Phone:319-754-6541
Mailing Address - Fax:319-754-6544
Practice Address - Street 1:1223 S GEAR AVE
Practice Address - Street 2:STE 202
Practice Address - City:WEST BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52655-1685
Practice Address - Country:US
Practice Address - Phone:319-754-6541
Practice Address - Fax:319-754-6544
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA21014208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0150797Medicaid
IA020013502OtherRRMC
IAAP1263223OtherDEA
IA150797Medicare ID - Type Unspecified
IA0150797Medicaid