Individual
DR. PHILLIP W. ANTUNES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2401 S 31ST ST, TEMPLE, TX 76508-0001
(254) 724-2111
Mailing address
PO BOX 844658, DALLAS, TX 75284-4658
(254) 724-2111
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
J6304
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0420754-01
—
TX
01
—
260045291
RR/MEDICARE
TX
01
—
83450F
BLUE SHIELD
TX
Enumeration date
03/20/2006
Last updated
09/04/2020
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