Individual
KENNETH E. PHILLIPS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
6161 S YALE AVE, ER DEPT, TULSA, OK 74136-1902
(918) 494-6528
(405) 749-4561
Mailing address
PO BOX 22063, DEPT 0491, TULSA, OK 74121-2063
(405) 751-4664
(405) 749-4561
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
3874
OK
207P00000X
Emergency Medicine Physician
E-10878
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100004840A
—
OK
01
—
P00199291
RR MEDICARE
OK
Enumeration date
05/01/2006
Last updated
11/07/2018
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