Provider Demographics
NPI:1831106897
Name:PHILLIPS, JOHN PATRICK (MD)
Entity Type:Individual
Prefix:
First Name:JOHN PATRICK
Middle Name:
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 1:1127 UNIVERSITY BLVD NE
Mailing Address - Street 2:MSC07 4090
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-1740
Mailing Address - Country:US
Mailing Address - Phone:505-272-5200
Mailing Address - Fax:
Practice Address - Street 1:1127 UNIVERSITY BLVD NE
Practice Address - Street 2:CARRIE TINGLEY HOSPITAL
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-1740
Practice Address - Country:US
Practice Address - Phone:505-272-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM87-2732080P0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0008XAllopathic & Osteopathic PhysiciansPediatricsNeurodevelopmental Disabilities