Provider Demographics
NPI:1972858637
Name:PHILLIPS-DWYER, ESTHER ELIZABETH (BS, M S, JD)
Entity Type:Individual
Prefix:
First Name:ESTHER
Middle Name:ELIZABETH
Last Name:PHILLIPS-DWYER
Suffix:
Gender:F
Credentials:BS, M S, JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 101277
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32910-1277
Mailing Address - Country:US
Mailing Address - Phone:321-373-1262
Mailing Address - Fax:
Practice Address - Street 1:1391 SAGOLA ST SE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32909-5110
Practice Address - Country:US
Practice Address - Phone:321-373-1262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL779750390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program