Individual
DR. JUSTIN D PHILLIPS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2 ST. VINCENT CIRCLE, LITTLE ROCK, AR 72205-5423
(501) 552-3000
(501) 552-4181
Mailing address
P.O. BOX 9150, PADUCAH, KY 42002-9150
(270) 744-9600
(270) 744-0834
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
E5814
AR
207P00000X
Emergency Medicine Physician
Primary
P6061
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1477747582
BCBS
AR
05
—
180290001
—
AR
05
—
317651301
—
TX
05
—
317651302
—
TX
05
—
317651303
—
TX
01
—
P01198742
MEDICARE RAILROAD
TX
Enumeration date
08/31/2007
Last updated
10/14/2013
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