Provider Demographics
NPI:1720042732
Name:PHILLIPS, DANIEL B (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:B
Last Name:PHILLIPS
Suffix:
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 1:690 GUZZI LN
Mailing Address - Street 2:SUITE C
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-5289
Mailing Address - Country:US
Mailing Address - Phone:209-533-0333
Mailing Address - Fax:209-533-0782
Practice Address - Street 1:690 GUZZI LN
Practice Address - Street 2:SUITE C
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-5289
Practice Address - Country:US
Practice Address - Phone:209-533-0333
Practice Address - Fax:209-533-0782
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG56099207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ35562ZOtherMEDICARE ID
CACG6463OtherRR MEDICARE
CAP00002757OtherRR MEDICARE
CA00G560991OtherMEDICARE PTAN
CAZZZ35562ZOtherMEDICARE ID