Provider Demographics
NPI:1942257548
Name:GIRLING, PHILIP WILLIAM (MD)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:WILLIAM
Last Name:GIRLING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2267 TETON PLZ
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-6486
Mailing Address - Country:US
Mailing Address - Phone:208-522-0140
Mailing Address - Fax:208-524-7335
Practice Address - Street 1:2267 TETON PLZ
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-6486
Practice Address - Country:US
Practice Address - Phone:208-522-0140
Practice Address - Fax:208-524-7335
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM86212084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1942257548Medicaid
ID78119OtherBLUE CROSS
ID000010144418OtherREGENCE BLUE SHIELD
IDH19414Medicare UPIN
ID78119OtherBLUE CROSS