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Individual

JAMES LEE PHILLIPS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DO

Contact information

Practice address
4331 S. FREMONT, SPRINGFIELD, MO 65804
(417) 820-5000
(417) 820-5015
Mailing address
PO BOX 2580, SPRINGFIELD, MO 65801-2580
(417) 829-4620
(417) 829-4316

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
2009016967
MO
208000000X
Pediatrics Physician
R-7924
IA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1982799763
MO
01
431560263
TRICARE WEST
Enumeration date
10/04/2006
Last updated
09/19/2012
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