Provider Demographics
NPI:1669944971
Name:PHILLIPS, CODY MITCHELL (MD)
Entity type:Individual
Prefix:
First Name:CODY
Middle Name:MITCHELL
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:12234 PANAMA CITY BEACH PKWY STE B
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32407-2726
Mailing Address - Country:US
Mailing Address - Phone:850-233-2323
Mailing Address - Fax:850-233-1055
Practice Address - Street 1:12234 PANAMA CITY BEACH PKWY STE B
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32407-2726
Practice Address - Country:US
Practice Address - Phone:850-233-2323
Practice Address - Fax:850-233-1055
Is Sole Proprietor?:No
Enumeration Date:2018-12-27
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME153750207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine