Organization
COPPELL CLINIC, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RUSSELL WAYNE PHILLIPS D.O. (PHYSICIAN)
(972) 745-4446
Entity
Organization
Contact information
Practice address
171 N DENTON TAP RD, SUITE 200, COPPELL, TX 75019-2915
(972) 745-4446
(972) 745-2597
Mailing address
171 N DENTON TAP RD, SUITE 200, COPPELL, TX 75019-2915
(972) 745-4446
(972) 745-2597
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
J0197
TX
Other
Enumeration date
11/02/2009
Last updated
11/02/2009
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