Provider Demographics
NPI:1629201827
Name:DOOLEY, PHILLIP WEBB JR (MD)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:WEBB
Last Name:DOOLEY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9665 E HEREFORD DR
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-1874
Mailing Address - Country:US
Mailing Address - Phone:313-550-0672
Mailing Address - Fax:734-337-0510
Practice Address - Street 1:9665 E HEREFORD DR
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1874
Practice Address - Country:US
Practice Address - Phone:313-550-0672
Practice Address - Fax:734-337-0510
Is Sole Proprietor?:No
Enumeration Date:2009-09-03
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301088529208M00000X
OH35.094693207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3008462Medicaid
OHH030691Medicare PIN