1912991662 NPI number — DENNIS B PHELPS M.D.

Table of content: DENNIS B PHELPS M.D. (NPI 1912991662)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912991662 NPI number — DENNIS B PHELPS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PHELPS
Provider First Name:
DENNIS
Provider Middle Name:
B
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1912991662
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/12/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 50706
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA BARBARA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93150-0706
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-963-3757
Provider Business Mailing Address Fax Number:
805-564-3332

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2323 DE LA VINA ST
Provider Second Line Business Practice Location Address:
SUITE 208
Provider Business Practice Location Address City Name:
SANTA BARBARA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93105-3877
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-563-3135
Provider Business Practice Location Address Fax Number:
805-845-8494
Provider Enumeration Date:
09/08/2005

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: 207XS0106X , with the licence number:  C35221 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00C352210 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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