1285683805 NPI number — ROBERT RAYMOND PHILLIPS M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285683805 NPI number — ROBERT RAYMOND PHILLIPS M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

PHILLIPS

Provider First Name:

ROBERT

Provider Middle Name:

RAYMOND

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

M

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:

1285683805

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

06/10/2019

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 6369

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

HELENA

Provider Business Mailing Address State Name:

MT

Provider Business Mailing Address Postal Code:

59604-6369

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

406-447-2828

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

2550 E BROADWAY ST

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

HELENA

Provider Business Practice Location Address State Name:

MT

Provider Business Practice Location Address Postal Code:

59601

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

406-457-4180

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

05/09/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207R00000X , with the licence number:  MD00035268 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207R00000X , with the licence number: 36103 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207RC0000X , with the licence number: MD00035268 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207RC0000X , with the licence number: 36103 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 5486PH . This is a "REGENCE BLUE SHIELD" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
• Identifier: MD1868 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
• Identifier: 7870297 . This is a "AETNA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
• Identifier: 82107 . This is a "L&I AND CRIME VICTIMS FOR SJMC" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
• Identifier: 8358863 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
• Identifier: G010 . This is a "TRI WEST (TRICARE)" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
• Identifier: 1285683805 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
• Identifier: P00049744 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
• Identifier: 0279978 . This is a "L&I AND CRIME VICTIMS FOR PHMG" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".