Individual
MR. MICHAEL WAYNE PHILLIPS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
719 W COKE RD, PRESBYTERIAN HOSPITAL WINNSBORO, WINNSBORO, TX 75494
(903) 342-5227
(903) 342-4121
Mailing address
7390 GIRAFFE RD, GILMER, TX 75644
(903) 725-5267
(903) 725-6436
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
CRNA41986
TX
367500000X
Certified Registered Nurse Anesthetist
Primary
RN545795
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003290602
—
TX
01
—
84759U
BLUE CROSS BLUE SHIELD
TX
Enumeration date
08/08/2006
Last updated
07/08/2007
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