Provider Demographics
NPI:1548254717
Name:PHILLIPS, PAUL A (DO)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:A
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38135 MARKET SQ
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542-7505
Mailing Address - Country:US
Mailing Address - Phone:813-528-4975
Mailing Address - Fax:
Practice Address - Street 1:38135 MARKET SQ
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33542-7505
Practice Address - Country:US
Practice Address - Phone:813-782-8829
Practice Address - Fax:813-355-5099
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS98792085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00943872 - UCCOtherRAILROAD MEDICARE
FLP00669491OtherRR MEDICARE
FL000482800Medicaid
FLAV520X - UCCMedicare PIN
FL000482800Medicaid
FLP00943872 - UCCOtherRAILROAD MEDICARE