Provider Demographics
NPI:1447713805
Name:PHIPPS, KYLE CAMPBELL (DO)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:CAMPBELL
Last Name:PHIPPS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 S MONACO PKWY APT 3
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80224-2051
Mailing Address - Country:US
Mailing Address - Phone:714-501-4366
Mailing Address - Fax:
Practice Address - Street 1:500 W THOMAS RD STE 600
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4221
Practice Address - Country:US
Practice Address - Phone:602-406-4433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-11
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AZ009673207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program