Basic Information
| Provider Information | |||||||||
| NPI: | 1235173899 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PHILLIPS | ||||||||
| FirstName: | DEXTER | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6696 US HIGHWAY 20A | ||||||||
| Address2: | |||||||||
| City: | DELTA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43515 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4193353242 | ||||||||
| FaxNumber: | 4198229008 | ||||||||
| Practice Location | |||||||||
| Address1: | 6696 US HIGHWAY 20A | ||||||||
| Address2: | |||||||||
| City: | DELTA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43515 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4198223242 | ||||||||
| FaxNumber: | 4198229008 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2006 | ||||||||
| LastUpdateDate: | 01/08/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 34-00-2700-P | OH | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207Q00000X | 34-00-2700-P | OH | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 34-002700 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00385719 | 01 | OH | RAILROAD MEDICARE | OTHER | 0378201 | 05 | OH | MEDICAID |