Individual
RANDALL R PHILLIPS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
855 MONTGOMERY ST, FORT WORTH, TX 76107-2553
(817) 735-5450
(817) 735-5454
Mailing address
PO BOX 99335, FORT WORTH, TX 76199-0335
(817) 735-5450
(817) 735-5454
Taxonomy
Speciality
Code
Description
License number
State
207YS0123X
Facial Plastic Surgery Physician
Primary
H6916
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
114589804
—
TX
01
—
240004825
RAILROAD MEDICARE PIN
TX
01
—
846875
BCBS
TX
Enumeration date
06/29/2006
Last updated
01/27/2009
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