Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | 221 | TX |
NPI | 1134486277 |
---|---|
Provider Name | Sterling Kenton Phillips |
First Address | Lubbock, TX 79407-2408 |
Second Address | Lubbock, TX 79407-2408 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2012 |
Last Update Date | 09/08/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
145567702 | (05) | TX |