Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | L7848 | TX |
NPI | 1225036759 |
---|---|
Provider Name | Dr. William Ralph Phillips III |
First Address | Dallas, TX 75225-6203 |
Second Address | Dallas, TX 75225-6203 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2005 |
Last Update Date | 07/03/2013 |