Healthcare Provider Details

I. General information

NPI: 1265448518
Provider Name (Legal Business Name): DAVID M. PHILLIPS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 12/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8010 MOFFETT RD
SEMMES AL
36575-5406
US

IV. Provider business mailing address

PO BOX 850489
MOBILE AL
36685-0489
US

V. Phone/Fax

Practice location:
  • Phone: 251-645-8946
  • Fax: 251-645-8976
Mailing address:
  • Phone: 251-342-3949
  • Fax: 251-631-3361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number00008473
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: