Provider Demographics
NPI:1962013870
Name:PHILIP RYAN M CAMILON, MD
Entity Type:Organization
Organization Name:PHILIP RYAN M CAMILON, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP RYAN
Authorized Official - Middle Name:MOLARTE
Authorized Official - Last Name:CAMILON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-900-1117
Mailing Address - Street 1:505 S MAIN ST STE 275
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4547
Mailing Address - Country:US
Mailing Address - Phone:714-836-6607
Mailing Address - Fax:714-836-6600
Practice Address - Street 1:505 S MAIN ST STE 275
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4547
Practice Address - Country:US
Practice Address - Phone:714-836-6607
Practice Address - Fax:714-836-6600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-13
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
No207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric OtolaryngologyGroup - Single Specialty