Provider Demographics
NPI:1679587141
Name:PHILLIPS, CHARLES ROY (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:ROY
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6769 N FRESNO ST
Mailing Address - Street 2:#210
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-3715
Mailing Address - Country:US
Mailing Address - Phone:559-440-1500
Mailing Address - Fax:550-440-1517
Practice Address - Street 1:6769 N FRESNO ST
Practice Address - Street 2:#210
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-3715
Practice Address - Country:US
Practice Address - Phone:559-440-1500
Practice Address - Fax:550-440-1517
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2013-08-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG16783207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A39906Medicare UPIN