Individual
DR. TIMOTHY MARTIN PHILLIPS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1465 S GRAND BLVD, SAINT LOUIS, MO 63104-1003
(210) 857-4174
(314) 268-4176
Mailing address
1465 S GRAND BLVD, SAINT LOUIS, MO 63104-1003
(210) 857-4174
(314) 268-4176
Taxonomy
Speciality
Code
Description
License number
State
2088P0231X
Pediatric Urology Physician
Primary
2018010765
MO
2088P0231X
Pediatric Urology Physician
N6582
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
286858001
—
TX
Enumeration date
07/18/2006
Last updated
01/15/2021
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