Individual
JOE EDWARD PHILLIPS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
921 NE 13TH ST, OKLAHOMA CITY, OK 73104-5007
(405) 456-1165
Mailing address
3711 S ANDERSON RD, OKLAHOMA CITY, OK 73150-2932
(405) 582-2499
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1462
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1462
PA
OK
Enumeration date
08/02/2006
Last updated
07/06/2016
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