Individual
MARK B PHILLIPS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4545 EMERSON EXPRESSWAY, JACKSONVILLE, FL 32207
(904) 399-2600
Mailing address
PO BOX 44008, UFJP PROVIDER ENROLLMENT, JACKSONVILLE, FL 32231-4008
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
ME0047040
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000378452D
—
GA
05
—
274660300
—
FL
Enumeration date
10/17/2006
Last updated
10/16/2013
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