Individual
DR. DOUGLAS LEON PHILLIPS II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
8607 TEMPLE DR, FORT WAYNE, IN 46809-3048
(260) 478-9220
(260) 478-9172
Mailing address
1234 E DUPONT RD, SUITE 1, FORT WAYNE, IN 46825-1545
(260) 373-9700
(260) 458-5664
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02001562
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100362730
—
IN
Enumeration date
11/10/2005
Last updated
10/16/2012
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