Provider Demographics
NPI:1962491118
Name:PHILLIPS, DEAN JAMES (DO)
Entity Type:Individual
Prefix:DR
First Name:DEAN
Middle Name:JAMES
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:741 SAN RAPHAEL ST
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34759-3909
Mailing Address - Country:US
Mailing Address - Phone:315-778-1373
Mailing Address - Fax:
Practice Address - Street 1:741 SAN RAPHAEL ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34759-3909
Practice Address - Country:US
Practice Address - Phone:315-778-1373
Practice Address - Fax:315-786-5058
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01022015362085R0202X
SCDO8832085R0202X
NC2004013042085R0202X
FLOS91212085R0202X
NY189847-12085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG67010Medicare UPIN