Individual
JESSE E PHILLIPS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4632 S 25TH ST, FORT PIERCE, FL 34981-5057
(772) 464-9595
(772) 460-2624
Mailing address
4632 S 25TH ST, FORT PIERCE, FL 34981-5057
(772) 464-9595
(772) 460-2624
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
01040385A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00000209641
ANTHEM BCBS
IN
05
—
100462620A
—
IN
Enumeration date
07/27/2005
Last updated
12/09/2024
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