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Individual
BRYAN J PHILLIPS
Active
Individual
BRYAN J PHILLIPS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
036098037
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0031600193
BLUE SHIELD
IL
05
—
036098037
—
IL
01
—
180039547
RAILROAD MEDICARE
IL
01
—
3970320001
DMERC
IL
01
—
K46495
MEDICARE PROVIDER NUMBER
IL
Enumeration date
06/22/2005
Last updated
07/26/2013
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