Individual
DR. MARK C PHILLIPS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
860 N MYRTLE RD, MYRTLE CREEK, OR 97457-9626
(541) 863-3410
(541) 863-6435
Mailing address
860 N MYRTLE RD, MYRTLE CREEK, OR 97457-9626
(541) 863-3410
(541) 863-6435
Taxonomy
Speciality
Code
Description
License number
State
173000000X
Legal Medicine
MD18731
OR
208D00000X
General Practice Physician
Primary
MD18731
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
065586
—
OR
01
—
MD18731
STATE LICENSE #
OR
Enumeration date
07/12/2006
Last updated
03/07/2023
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