Individual
MR. THIRSTON S PHILLIPS JR.
Active
Individual
MR. THIRSTON S PHILLIPS JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
200400575
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
136YW
BLUE CROSS AND BLUE SHIEL
NC
01
—
195400
MEDCOST PROVIDER ID
NC
01
—
612107500
OWCP PROVIDER ID
NC
05
—
89136YW
—
NC
05
—
Q0057F
—
SC
Enumeration date
07/11/2006
Last updated
10/27/2021
Update your record
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