Provider Demographics
NPI:1669478467
Name:PHILLIPS, DOYLE CLAUDE JR (MD)
Entity Type:Individual
Prefix:DR
First Name:DOYLE
Middle Name:CLAUDE
Last Name:PHILLIPS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:631 NE 25TH AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34470-7033
Mailing Address - Country:US
Mailing Address - Phone:352-237-8889
Mailing Address - Fax:352-237-9583
Practice Address - Street 1:631 NE 25TH AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34470-7033
Practice Address - Country:US
Practice Address - Phone:352-237-8889
Practice Address - Fax:352-237-9583
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-27
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME64161207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL26424OtherBLUE CROSS BLUE SHIELD
FL252414700Medicaid
FL26424Medicare PIN
FL26424OtherBLUE CROSS BLUE SHIELD