Provider Demographics
NPI: | 1326262874 |
---|---|
Name: | HABIB, PHILLIP JAMES (MD) |
Entity type: | Individual |
Prefix: | DR |
First Name: | PHILLIP |
Middle Name: | JAMES |
Last Name: | HABIB |
Suffix: | |
Gender: | M |
Credentials: | MD |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 5035 VIA DELRAY |
Mailing Address - Street 2: | |
Mailing Address - City: | DELRAY BEACH |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33484-1315 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 561-637-0500 |
Mailing Address - Fax: | 561-637-0055 |
Practice Address - Street 1: | 5035 VIA DELRAY |
Practice Address - Street 2: | |
Practice Address - City: | DELRAY BEACH |
Practice Address - State: | FL |
Practice Address - Zip Code: | 33484-1315 |
Practice Address - Country: | US |
Practice Address - Phone: | 561-637-0500 |
Practice Address - Fax: | 561-637-0055 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2007-04-13 |
Last Update Date: | 2023-09-20 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
FL | ME115470 | 207RA0001X, 207RC0000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207RA0001X | Allopathic & Osteopathic Physicians | Internal Medicine | Advanced Heart Failure and Transplant Cardiology |
No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
OH | 57.011499 | Medicare UPIN |