Individual
PHILLIP WILLIE TAN POLIDO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
2350 COUNTRY HILLS DR STE A, ANTIOCH, CA 94509-7436
(925) 757-0800
(925) 757-2160
Mailing address
2350 COUNTRY HILLS DR STE A, ANTIOCH, CA 94509-7436
(925) 757-0800
(925) 757-2160
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
A32794
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A327940
—
CA
01
—
020008734
MEDICARE RAILROAD
CA
Enumeration date
10/13/2006
Last updated
02/12/2021
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