Basic Information
| Provider Information | |||||||||
| NPI: | 1548446487 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PHILLIPS | ||||||||
| FirstName: | FATIMA | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | M.D., M.P.H., PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 224 HAILI ST | ||||||||
| Address2: | BLDG B | ||||||||
| City: | HILO | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967202975 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8089691427 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1178 KINOOLE ST | ||||||||
| Address2: | BLDG B | ||||||||
| City: | HILO | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967207206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8089691427 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2008 | ||||||||
| LastUpdateDate: | 08/31/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | ME83731 | FL | N | Allopathic & Osteopathic Physicians | Family Medicine | 208D00000X | ME83731 | FL | Y | Allopathic & Osteopathic Physicians | General Practice | 207Q00000X | MD-15428 | HI | N | Allopathic & Osteopathic Physicians | Family Medicine | 208D00000X | MD-15428 | HI | N | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.