Individual
DR. BRADLEY PHILLIPS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
90 HOPE DR BLDG 6000, MOUNTAIN HOME AFB, ID 83648-1062
(208) 828-7362
(208) 828-1916
Mailing address
90 HOPE DR, MOUNTAIN HOME AFB, ID 83648-1057
(208) 828-7362
(208) 828-1916
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
M-17656
ID
2083A0100X
Aerospace Medicine Physician
M-17656
ID
208D00000X
General Practice Physician
0101270994
VA
208D00000X
General Practice Physician
Primary
M-17656
ID
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/11/2019
Last updated
03/03/2026
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