Phillips, Jesse E

Phillips, Jesse E is an individual health care provider with primary practice located at 1801 Se Hillmoor Dr Suite B105, Port St Lucie FL 34952-7553. He recently has only one registered license in Allopathic & Osteopathic Physicians / Otolaryngology, which is considered as his primary health care specialty. Phillips, Jesse E can be contacted via phone (772) 398-9911.

Contact Information

Primary practice address
1801 Se Hillmoor Dr Suite B105 Port St Lucie FL 34952-7553
Phone: (772) 398-9911
Fax: (772) 398-4374
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Otolaryngology 207Y00000X 01040385A Indiana

Profile Details

NPI number 1457351983
LBN Legal business name Phillips, Jesse E
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 27th, 2005
Last updated Jan 5th, 2015 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1457351983 NPPES
Indiana Other 00000209641 ANTHEM BCBS
Indiana MEDICAID 100462620A ANTHEM BCBS

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