Provider Demographics
NPI:1134228893
Name:PHILLIPS, HARVEY GENE JR (MD)
Entity type:Individual
Prefix:DR
First Name:HARVEY
Middle Name:GENE
Last Name:PHILLIPS
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:4800 BELFORT ROAD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256
Mailing Address - Country:US
Mailing Address - Phone:904-398-3262
Mailing Address - Fax:904-265-4807
Practice Address - Street 1:1348 SOUTH 18TH STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-4755
Practice Address - Country:US
Practice Address - Phone:904-261-0878
Practice Address - Fax:904-277-7054
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2014-08-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME 97783207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL278127100Medicaid
FLAD776ZMedicare PIN