Provider Demographics
NPI:1184912123
Name:DOYLE C PHILLIPS MD PA
Entity type:Organization
Organization Name:DOYLE C PHILLIPS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOYLE
Authorized Official - Middle Name:CLAUDE
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:352-237-8889
Mailing Address - Street 1:631 NE 25TH AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34470-7033
Mailing Address - Country:US
Mailing Address - Phone:352-237-8889
Mailing Address - Fax:352-237-9583
Practice Address - Street 1:631 NE 25TH AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34470-7033
Practice Address - Country:US
Practice Address - Phone:352-237-8889
Practice Address - Fax:352-237-9583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-12
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME64161207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL252414700Medicaid
26424Medicare PIN