Basic Information
| Provider Information | |||||||||
| NPI: | 1285049510 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CAMILON | ||||||||
| FirstName: | PHILIP RYAN | ||||||||
| MiddleName: | MOLARTE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 50 NORTH MEDICAL DR SOM 3C120 | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841320001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8015817514 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 505 S MAIN ST STE 275 | ||||||||
| Address2: | |||||||||
| City: | ORANGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928684547 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7148366607 | ||||||||
| FaxNumber: | 7148366600 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2014 | ||||||||
| LastUpdateDate: | 06/05/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207YP0228X | 11273467-1205 | UT | N | Allopathic & Osteopathic Physicians | Otolaryngology | Pediatric Otolaryngology | 208600000X | 37240 | SC | N | Allopathic & Osteopathic Physicians | Surgery | 207Y00000X | 264285 | MA | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
No ID Information.