Provider Demographics
NPI:1548446487
Name:PHILLIPS, FATIMA C (MD, MPH, PHD)
Entity type:Individual
Prefix:
First Name:FATIMA
Middle Name:C
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MD, MPH, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 HAILI ST
Mailing Address - Street 2:BLDG B
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-2975
Mailing Address - Country:US
Mailing Address - Phone:808-969-1427
Mailing Address - Fax:
Practice Address - Street 1:1178 KINOOLE ST
Practice Address - Street 2:BLDG B
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-7206
Practice Address - Country:US
Practice Address - Phone:808-969-1427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-10
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83731207Q00000X, 208D00000X
HIMD-15428207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine