Basic Information
| Provider Information | |||||||||
| NPI: | 1891321337 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AYRES | ||||||||
| FirstName: | PHILIPPE | ||||||||
| MiddleName: | FREIRE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 475 VINE ST. | ||||||||
| Address2: | BOWMAN GRAY CENTER FOR MEDICAL EDUCATION | ||||||||
| City: | WINSTON-SALEM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4435386258 | ||||||||
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| Practice Location | |||||||||
| Address1: | 475 VINE ST. | ||||||||
| Address2: | BOWMAN GRAY CENTER FOR MEDICAL EDUCATION | ||||||||
| City: | WINSTON-SALEM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3367162011 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2020 | ||||||||
| LastUpdateDate: | 04/30/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 146D00000X | N | Emergency Medical Service Providers | Personal Emergency Response Attendant | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.