Provider Demographics
NPI:1760469548
Name:TIRMAN, PHILLIP FJ (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:FJ
Last Name:TIRMAN
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 1:5776D LINDERO CANYON RD # 469
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362-4088
Mailing Address - Country:US
Mailing Address - Phone:424-488-1874
Mailing Address - Fax:310-378-0347
Practice Address - Street 1:5776D LINDERO CANYON RD STE 469
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-4088
Practice Address - Country:US
Practice Address - Phone:310-378-0547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA491482085R0202X, 2085D0003X
NJ25MA071792002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085D0003XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Neuroimaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJE84329Medicare UPIN
CA00A491480Medicaid
NJ8563608Medicaid
CA00A491483Medicare PIN
CA300121749OtherRAILROAD MEDICARE
NJ051300Medicare ID - Type Unspecified