Provider Demographics
NPI:1912991662
Name:PHELPS, DENNIS B (MD)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:B
Last Name:PHELPS
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:PO BOX 50706
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93150-0706
Mailing Address - Country:US
Mailing Address - Phone:805-963-3757
Mailing Address - Fax:805-564-3332
Practice Address - Street 1:2323 DE LA VINA ST
Practice Address - Street 2:SUITE 208
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-3877
Practice Address - Country:US
Practice Address - Phone:805-563-3135
Practice Address - Fax:805-845-8494
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-08
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC35221207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C352210Medicaid
CA00C352210Medicaid
CA0440630001Medicare NSC
CAC35221BMedicare PIN