Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 24277 | OK |
Y | 207XS0117X | Orthopaedic Spine Surgeon | 24277 | OK |
NPI | 1023097276 |
---|---|
Provider Name | Preston Phillips |
First Address | Tulsa, OK 74136-3310 |
Second Address | Tulsa, OK 74136-7816 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/01/2006 |
Last Update Date | 19/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G58852 | (02) | OK |