Individual
MARYANNE DEFOREST PHILLIPS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
5052 JONES BLVD, 135, LAS VEGAS, NV 89118
(702) 822-1881
(702) 822-1880
Mailing address
10620 SOUTHERN HIGHLANDS PKWY, 110-250, LAS VEGAS, NV 89141-4369
(702) 822-1881
(702) 822-1880
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
7635
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A637530
BLUE SHIELD
CA
05
—
00A637530
—
CA
Enumeration date
07/28/2006
Last updated
04/13/2012
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