Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 1618 | SC |
N | 207Q00000X | Family Doctor | 47984 | CO |
N | 207Q00000X | Family Doctor | M8253 | TX |
N | 207Q00000X | Family Doctor | TL1618 | SC |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 1618 | SC |
NPI | 1194994210 |
---|---|
Provider Name | Troy Mac Phillips |
First Address | York, SC 29745-9458 |
Second Address | Greer, SC 29650-2446 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2008 |
Last Update Date | 23/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
016182 | (05) | SC |
48220736 | (05) | CO |
P01221638 | RAILROAD MEDICARE (01) | SC |