Provider Demographics
NPI:1174515449
Name:PHILLIPS, JEANNE VESEY (MD)
Entity type:Individual
Prefix:
First Name:JEANNE
Middle Name:VESEY
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 480
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93902-0480
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:30 GARDEN CT
Practice Address - Street 2:B
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-5302
Practice Address - Country:US
Practice Address - Phone:831-647-1123
Practice Address - Fax:831-886-1529
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD25435207RC0000X
CAC145503207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR022735Medicaid
ORP00893300OtherRR MEDICARE
ORR159879Medicare PIN
OR022735Medicaid
ORR154533Medicare PIN
ORP00893300OtherRR MEDICARE
ORI13938Medicare UPIN
ORR134882Medicare PIN