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Individual

DR. PHILLIP MABON WILLIFORD

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Taxonomy

Speciality
Code
Description
License number
State
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
26483
NC
207NS0135X
Procedural Dermatology Physician
26483
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
2005036000
WV
01
4671710
AETNA
01
5552
PARTNERS
05
5940478
VA
01
64002
MEDCOST
01
70016802
RR MEDICARE
01
88074
BCBS
05
8988074
NC
05
N26483
SC
Enumeration date
12/19/2005
Last updated
11/15/2010
Update your record

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