Provider Demographics
NPI:1831270180
Name:HIPPS, PHILLIP L (MD)
Entity type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:L
Last Name:HIPPS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5040 N 15TH AVENUE
Mailing Address - Street 2:202
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015
Mailing Address - Country:US
Mailing Address - Phone:602-248-0123
Mailing Address - Fax:602-248-8506
Practice Address - Street 1:5040 N 15TH AVE
Practice Address - Street 2:202
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-3328
Practice Address - Country:US
Practice Address - Phone:602-248-0123
Practice Address - Fax:602-248-8506
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ5658207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C99647Medicare UPIN