Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | F9951 | TX |
NPI | 1013983774 |
---|---|
Provider Name | Joseph Theodore Phillips JR. |
First Address | Dallas, TX 75214-3922 |
Second Address | Dallas, TX 75214-3922 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2006 |
Last Update Date | 08/09/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
123466802 | (05) | TX |
E09223 | (02) | TX |