Provider Demographics
NPI:1194428029
Name:PHILLIPS, ANDREW JAY (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:JAY
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:986840 NEBRASKA MEDICAL CENTER
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68198-6840
Mailing Address - Country:US
Mailing Address - Phone:402-559-5388
Mailing Address - Fax:
Practice Address - Street 1:NEBRASKA MEDICAL CENTER
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68198-4810
Practice Address - Country:US
Practice Address - Phone:402-559-5388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-22
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program