Basic Information
| Provider Information | |||||||||
| NPI: | 1740515311 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PHILLIPS | ||||||||
| FirstName: | ROXANNA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 250 FORT ST | ||||||||
| Address2: | PO BOX 410 | ||||||||
| City: | NEAH BAY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983570410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5758945594 | ||||||||
| FaxNumber: | 3606452305 | ||||||||
| Practice Location | |||||||||
| Address1: | 250 FORT ST | ||||||||
| Address2: | |||||||||
| City: | NEAH BAY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983570410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5758945594 | ||||||||
| FaxNumber: | 3606452305 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/14/2009 | ||||||||
| LastUpdateDate: | 04/28/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | MD2012-0533 | NM | Y | Allopathic & Osteopathic Physicians | Pediatrics | 208D00000X | MD2012-0533 | NM | N | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.