Provider Demographics
NPI:1336265610
Name:PAILEY, PHILIP MW (MD)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:MW
Last Name:PAILEY
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 1:2214 VISTA RODEO DR
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92019-3564
Mailing Address - Country:US
Mailing Address - Phone:619-579-0460
Mailing Address - Fax:619-464-1311
Practice Address - Street 1:2214 VISTA RODEO DR
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92019-3564
Practice Address - Country:US
Practice Address - Phone:619-579-0460
Practice Address - Fax:619-464-1311
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG24881207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G248811Medicaid
CAA89406Medicare UPIN
CA00G248811Medicaid