Provider Demographics
NPI:1396586194
Name:PHILLIPS, MARTIN ANDREW (PHD)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:ANDREW
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1129 RYCROFT ST APT 203
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-2844
Mailing Address - Country:US
Mailing Address - Phone:808-953-8603
Mailing Address - Fax:
Practice Address - Street 1:5426 CALIFORNIA AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98136-1513
Practice Address - Country:US
Practice Address - Phone:583-020-6462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program