Healthcare Provider Details

I. General information

NPI: 1073501219
Provider Name (Legal Business Name): CHRISTOPHER D PHILLIPS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 08/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6555 PERKINS RD SUITE 300
BATON ROUGE LA
70808-4237
US

IV. Provider business mailing address

6555 PERKINS RD SUITE 300
BATON ROUGE LA
70808-4237
US

V. Phone/Fax

Practice location:
  • Phone: 225-810-3342
  • Fax: 225-810-3348
Mailing address:
  • Phone: 225-810-3342
  • Fax: 225-810-3348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD202075
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number217691
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberD50946
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD2012-0560
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: