Provider Demographics
NPI:1972513919
Name:DREISBACH, PHILIP BRIEN (MD)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:BRIEN
Last Name:DREISBACH
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 1:34490 BOB HOPE DR.
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-0000
Mailing Address - Country:US
Mailing Address - Phone:760-568-3613
Mailing Address - Fax:760-340-5189
Practice Address - Street 1:34490 BOB HOPE DR.
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-0000
Practice Address - Country:US
Practice Address - Phone:760-568-3613
Practice Address - Fax:760-340-5189
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG19293207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G192930Medicaid
CA757111683OtherRAILROAD MEDICARE
CA00G192930Medicare ID - Type Unspecified