Provider Demographics
NPI:1548420201
Name:PHILLIPS, LORNIE JAMES II (MD)
Entity Type:Individual
Prefix:DR
First Name:LORNIE
Middle Name:JAMES
Last Name:PHILLIPS
Suffix:II
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 1:1411 E 31ST ST
Mailing Address - Street 2:QIC 22134
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94602-1018
Mailing Address - Country:US
Mailing Address - Phone:510-437-4089
Mailing Address - Fax:510-437-5017
Practice Address - Street 1:1411 E 31ST ST
Practice Address - Street 2:QIC 22134
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94602-1018
Practice Address - Country:US
Practice Address - Phone:510-437-4089
Practice Address - Fax:510-437-5017
Is Sole Proprietor?:No
Enumeration Date:2008-06-16
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA91829208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery