Individual
CONSTANTINE PHIRIPES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4115 E LANCASTER AVE, FORT WORTH, TX 76103-3614
(817) 796-7370
(817) 764-0714
Mailing address
PO BOX 746079, ATLANTA, GA 30374-6079
(312) 733-9730
(773) 866-8014
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
S7117
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G56470
BLUE CROSS
CA
01
—
942497568
BLUE SHIELD
CA
05
—
GR0006345
—
CA
05
—
GR0066340
—
CA
01
—
ZZZ38477Z
MEDICARE GROUP ID
CA
Enumeration date
01/27/2006
Last updated
07/21/2022
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