Individual
PHILLIP BLEVINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5180
(601) 984-5183
Mailing address
PO BOX 24146, JACKSON, MS 39225-4146
(601) 984-5180
(601) 984-5183
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
07405
MS
2082S0099X
Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician
07405
MS
2082S0105X
Surgery of the Hand (Plastic Surgery) Physician
07405
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00012332
—
MS
Enumeration date
07/03/2006
Last updated
06/13/2012
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