Individual
MARK G PHILLIPS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2013 PONCE DELEON AVE, PALM BEACH PATHOLOGY PA, WEST PALM BEACH, FL 33407-6019
(561) 659-0770
(561) 802-3504
Mailing address
300 BUTLER ST, PALM BEACH PATHOLOGY PA, WEST PALM BEACH, FL 33407-6006
(561) 659-0770
(561) 802-3504
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
ME55124
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
057823100
—
FL
01
—
14419
BLUE CROSS BLUE SHIELD
FL
01
—
220011725
RAILROAD MEDICARE
—
Enumeration date
11/14/2005
Last updated
08/27/2010
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