Charles Roy Phillips, MD
Individual provider Active NPI Emergency Medicine Physician · Fresno, CA
NPI 1679587141 · NPPES record last updated Aug 26, 2013
Key facts
- NPI
- 1679587141
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Emergency Medicine Physician 207P00000X
- License
- G16783 (CA)
- Practice address
- 6769 N Fresno St
#210
Fresno, CA 93710-3715 - Phone
- (559) 440-1500
- Fax
- (550) 440-1517
- NPI assigned
- Jul 28, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G16783 | CA | MD | Emergency Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sierra Rural Physicians, Inc. | Emergency Medicine | Past | Accepting new patients |
| Clovis Urgent Care Medical Center | Past | Accepting new patients | |
| Medical Group of San Joaquin Valley | Past |
Accepting new patients | |
| Quantum Healthcare Medical Associates Inc. | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | G16783 | CA | Yes |
Addresses
Primary practice location
6769 N Fresno St
#210
Fresno, CA 93710-3715
Mailing address
6769 N Fresno St
#210
Fresno, CA 93710-3715
Phone (559) 440-1500
Other providers in Fresno, CA
- Philip P Corneliuson DDS Inc
- Oksana Philips
- Amber Phillips
- Brandi Phillips
- Charis J Phillips
- Eleana Marie Phillips
- Erica Monique Phillips
- John Patrick Phillips
- Linette Marie Phillips
- Nichole Marie Phillips
All providers in Fresno, CA · Emergency Medicine Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 26, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.