Individual
PHILLIS CHERIE MIMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
5002 W LEMON ST, TAMPA, FL 33609-1104
(813) 286-0033
(813) 282-1806
Mailing address
PO BOX 25317, TAMPA, FL 33622-5317
(813) 286-0033
(813) 282-1806
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
4301070563
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
489790410
—
MI
01
—
700H262210
BLUE CROSS-BLUE CROSS
—
01
—
PM070563
COMMERCIAL-COMMERCIAL NUMBER
—
Enumeration date
11/02/2005
Last updated
11/05/2020
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