Healthcare Provider Details

I. General information

NPI: 1124021571
Provider Name (Legal Business Name): BARRY S PHILLIPS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 01/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4111 GATEWAY BLVD
NEWBURGH IN
47630-8954
US

IV. Provider business mailing address

PO BOX 1510
EVANSVILLE IN
47706-1510
US

V. Phone/Fax

Practice location:
  • Phone: 812-853-5300
  • Fax: 812-858-4660
Mailing address:
  • Phone: 812-853-5300
  • Fax: 812-858-4660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01044946A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: