Provider Demographics
NPI:1295758779
Name:PHIPPS, WILLIAM RUSSELL (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:RUSSELL
Last Name:PHIPPS
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12920 US HIGHWAY 1 STE A
Mailing Address - Street 2:
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-3772
Mailing Address - Country:US
Mailing Address - Phone:321-727-7992
Mailing Address - Fax:
Practice Address - Street 1:12920 US HIGHWAY 1 STE A
Practice Address - Street 2:
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-3772
Practice Address - Country:US
Practice Address - Phone:321-727-7992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350882672086S0102X, 2086S0127X, 208600000X
FLME1338912086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL102517900Medicaid