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CLYDE BENNETT PHILLIPS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1464 MEDICAL PARK CIR, TUPELO, MS 38801-6595
(662) 844-8699
(662) 844-7087
Mailing address
PO BOX 1768, TUPELO, MS 38802-1768
(662) 844-8699
(662) 844-7087

Taxonomy

Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
08406
MS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00010415
MS
01
2840610001
DMERC
01
P00007401
RAILROAD MEDICARE
Enumeration date
07/14/2005
Last updated
01/28/2009
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