Individual
EAN PHILLIPS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
13101 S DIXIE HWY STE 400, PINECREST, FL 33156-6530
(786) 467-5753
Mailing address
PO BOX 100905, ATLANTA, GA 30384-2727
(786) 594-6880
(352) 273-7388
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9113414
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
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Other
Enumeration date
06/04/2020
Last updated
01/26/2023
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