Provider Demographics
NPI:1992943781
Name:PHILIPPS, GUILLERMO A (MD)
Entity type:Individual
Prefix:DR
First Name:GUILLERMO
Middle Name:A
Last Name:PHILIPPS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-343-6050
Mailing Address - Fax:239-343-6051
Practice Address - Street 1:22655 BAYSHORE RD STE 110
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33980-2005
Practice Address - Country:US
Practice Address - Phone:941-235-4900
Practice Address - Fax:941-235-4901
Is Sole Proprietor?:No
Enumeration Date:2009-02-02
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1091472084N0402X, 2084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003748000Medicaid