Provider Demographics
NPI:1265494579
Name:PHILBRICK, DAREY A (MD)
Entity type:Individual
Prefix:MR
First Name:DAREY
Middle Name:A
Last Name:PHILBRICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 ORTING-KAPOWSIN HWY E
Mailing Address - Street 2:
Mailing Address - City:ORTING
Mailing Address - State:WA
Mailing Address - Zip Code:98360
Mailing Address - Country:US
Mailing Address - Phone:360-893-4515
Mailing Address - Fax:360-893-4590
Practice Address - Street 1:1301 ORTING-KAPOWSIN HWY E
Practice Address - Street 2:
Practice Address - City:ORTING
Practice Address - State:WA
Practice Address - Zip Code:98360
Practice Address - Country:US
Practice Address - Phone:360-893-4515
Practice Address - Fax:360-893-4590
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6662207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0040AVOtherBLUE CROSS BLUE SHIELD TX
TX181622100OtherDEPT OF LABOR
TX119756OtherSUPERIOR HEALTH PLAN
TX3975330001OtherDEMERC REGION C PALMETO
TX127632105Medicaid
TX3399136OtherBLUE LINK
TX8X1180OtherBLUE CROSS BLUE SHIELD TX
TX119756OtherSUPERIOR HEALTH PLAN
TX00867LMedicare PIN
TX0040AVOtherBLUE CROSS BLUE SHIELD TX