Provider Demographics
NPI:1922044908
Name:DARRAGH, PHILLIP E (DPM)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:E
Last Name:DARRAGH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2850 ARTESIA BLVD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-3419
Mailing Address - Country:US
Mailing Address - Phone:310-793-1158
Mailing Address - Fax:310-793-1161
Practice Address - Street 1:2850 ARTESIA BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90278-3419
Practice Address - Country:US
Practice Address - Phone:310-793-1158
Practice Address - Fax:310-793-1161
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE-3444213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E34440Medicaid
CAE-3444OtherSTATE LICENSE NUMBER
CAT19332Medicare UPIN
CAE-3444OtherSTATE LICENSE NUMBER