Provider Demographics
NPI:1689605925
Name:MAYER, PHILIP JEFFERY (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:JEFFERY
Last Name:MAYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9389 N HAGGERTY RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-4622
Mailing Address - Country:US
Mailing Address - Phone:734-582-9770
Mailing Address - Fax:734-582-9773
Practice Address - Street 1:9389 N HAGGERTY RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-4622
Practice Address - Country:US
Practice Address - Phone:734-582-9770
Practice Address - Fax:734-582-9773
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIPMO55444207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIB42719Medicare UPIN