Individual
DR. CHARLES ALLAN PHILLIPS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3301 MATLOCK RD, ARLINGTON, TX 76015-2908
(817) 472-4869
Mailing address
PO BOX 201606, DALLAS, TX 75320-1606
(972) 519-1940
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
J4436
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
140249721
—
TX
05
—
140249722
—
TX
05
—
140249728
—
TX
05
—
140249734
—
TX
01
—
83172Y
BCBS
TX
01
—
85160Y
BCBS
TX
01
—
85489F
BCBS
TX
01
—
930089501
RAILROAD
TN
01
—
930091997
MEDICARE RAILROAD
TX
01
—
930092000
MEDICARE RAILROAD
TX
Enumeration date
01/12/2006
Last updated
03/01/2011
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