1730150152 NPI number — DR. PHILIP A ISAAC MD

Table of content: DR. PHILIP A ISAAC MD (NPI 1730150152)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730150152 NPI number — DR. PHILIP A ISAAC MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ISAAC
Provider First Name:
PHILIP
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730150152
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/21/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7128 N FINGER ROCK PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85718-1406
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-818-5007
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7128 N FINGER ROCK PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85718-1406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-818-5007
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/01/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  ME79976 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 53330 . This is a "FL BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 275572600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: ME79976 . This is a "MD LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".