Individual
TRACY THOMAS PHILLIPS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
2001 CLUB MANOR DR STE S, MAUMELLE, AR 72113-7417
(501) 734-8085
(501) 734-8088
Mailing address
PO BOX 13554, MAUMELLE, AR 72113-0554
(501) 350-8505
(501) 488-1020
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
E1018
AR
208M00000X
Hospitalist Physician
E-1018
AR
261QP2300X
Primary Care Clinic/Center
E1018
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
129995003
—
AR
01
—
2Z0853
MEDICARE
AR
Enumeration date
07/12/2005
Last updated
05/29/2024
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