Provider Demographics
NPI:1730234451
Name:MCRILL, PHILIP ELIJAH (MD)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:ELIJAH
Last Name:MCRILL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3710 SW US VETERANS HOSPITAL ROAD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-2964
Mailing Address - Country:US
Mailing Address - Phone:503-220-8262
Mailing Address - Fax:503-721-7942
Practice Address - Street 1:1 MINNI TOHE DR
Practice Address - Street 2:
Practice Address - City:NEW TOWN
Practice Address - State:ND
Practice Address - Zip Code:58763-4400
Practice Address - Country:US
Practice Address - Phone:701-627-4701
Practice Address - Fax:701-627-4318
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2015-10-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ND8919207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND8HBZ39Medicare PIN