Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | D6131 | TX |
NPI | 1073510368 |
---|---|
Provider Name | Larry Ewing Phillips |
First Address | Marble Falls, TX 78654 |
Second Address | Marble Falls, TX 78654 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C20500 | (02) | TX |