Provider Demographics
NPI:1255432738
Name:PHILLIPS, JOHN SCOTT (DPM)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:SCOTT
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:970 E US HIGHWAY 36 STE B
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:OH
Mailing Address - Zip Code:43078-1889
Mailing Address - Country:US
Mailing Address - Phone:937-653-6105
Mailing Address - Fax:937-652-4650
Practice Address - Street 1:970 E US HIGHWAY 36 STE B
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:OH
Practice Address - Zip Code:43078-1889
Practice Address - Country:US
Practice Address - Phone:937-653-6105
Practice Address - Fax:937-652-4650
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3121213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2096146Medicaid
OH2096146Medicaid
OH0875142Medicare ID - Type Unspecified