Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | K1900 | TX |
NPI | 1659391878 |
---|---|
Provider Name | Dr. Serena L Phillips |
First Address | San Antonio, TX 78229-5900 |
Second Address | San Antonio, TX 78229-5900 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C20497 | (02) | TX |