Healthcare Provider Details

I. General information

NPI: 1912024563
Provider Name (Legal Business Name): CHRISTOPHER RAYMOND PHILLIPS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 KIANA COURT SUITE B
PADUCAH KY
42001-6787
US

IV. Provider business mailing address

100 KIANA COURT SUITE B
PADUCAH KY
42001-6787
US

V. Phone/Fax

Practice location:
  • Phone: 270-408-6100
  • Fax:
Mailing address:
  • Phone: 270-408-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number43448
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number43448
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: