Provider Demographics
NPI:1588125579
Name:PHILLIPS, JARED DEAN (DO)
Entity type:Individual
Prefix:DR
First Name:JARED
Middle Name:DEAN
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 MDG, UNIT 3215
Mailing Address - Street 2:
Mailing Address - City:RAMSTEIN AB
Mailing Address - State:GERMANY
Mailing Address - Zip Code:09094
Mailing Address - Country:DE
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:FLUGPLATZ
Practice Address - Street 2:
Practice Address - City:RAMSTEIN
Practice Address - State:GEB
Practice Address - Zip Code:66877
Practice Address - Country:DE
Practice Address - Phone:314-479-2025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-31
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCMDO.83729207Q00000X, 2083A0100X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Yes2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine