Provider Demographics
NPI:1831427939
Name:PHILLIPS, AMY MASON (MD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:MASON
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:AMY
Other - Middle Name:ELIZABETH
Other - Last Name:MASON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1919 W SWANN AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-2417
Mailing Address - Country:US
Mailing Address - Phone:813-254-7079
Mailing Address - Fax:
Practice Address - Street 1:1919 W SWANN AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-2417
Practice Address - Country:US
Practice Address - Phone:813-254-7079
Practice Address - Fax:813-443-8164
Is Sole Proprietor?:No
Enumeration Date:2009-12-01
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 127450208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018162000Medicaid