Philip C. Marin, MD Prof LLC

Primary specialty

Plastic Surgery PhysicianTaxonomy code 208200000X

License

40500 Issued in CO

Legal business name

PHILIP C. MARIN, MD PROF LLC

Practice address

650 Dittmer Ave
Pueblo, CO 81005-1212

Phone

(719) 565-1000

Fax

(719) 565-1111

NPI assigned

Oct 25, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Philip C. Marin, MDNPI 1205868544

Title

Owner

Phone

(719) 565-1000

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CO

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Philip Charles Marin, MD

  • Plastic Surgery Physician
  • Pueblo, CO
  • NPI 1205868544
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1193270400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193270400000",
    "number": "1497934558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "650 DITTMER AVE",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810051212",
            "telephone_number": "719-565-1000",
            "fax_number": "719-565-1111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "650 DITTMER AVE",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810051212",
            "telephone_number": "719-565-1000",
            "fax_number": "719-565-1111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHILIP C. MARIN, MD PROF LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-25",
        "last_updated": "2007-10-25",
        "status": "A",
        "authorized_official_last_name": "MARIN",
        "authorized_official_first_name": "PHILIP",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "719-565-1000",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Plastic Surgery",
            "state": "CO",
            "license": "40500",
            "primary": true
        },
        {
            "code": "2082S0105X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Plastic Surgery, Surgery of the Hand",
            "state": "CO",
            "license": "40500",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashley Jo Phelps, PHD
• Hillary Anne Phelps, COTA
• Marsha Irene Phelps, LPC
• Susan Renee Phelps, L.AC.
• PHHC Acquisition Corp.
• Brandi Philipps
• Cody Phillips
• Jennifer Phillips
• Kristie Phillips
• Marisa K Phillips, NP

• Plastic Surgery Physician in Pueblo, CO
• Providers in Pueblo, CO by specialty
• Plastic Surgery Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.