Provider Demographics
NPI:1295116242
Name:AMES, PHILIP LODGE (MD)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:LODGE
Last Name:AMES
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:217 MANATEE AVE E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-1931
Mailing Address - Country:US
Mailing Address - Phone:941-748-1818
Mailing Address - Fax:941-746-1055
Practice Address - Street 1:217 MANATEE AVE E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-1931
Practice Address - Country:US
Practice Address - Phone:941-748-1818
Practice Address - Fax:941-746-1055
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-16
Last Update Date:2021-11-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MS26687207W00000X
TN58966207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty