Healthcare Provider Details

I. General information

NPI: 1649269564
Provider Name (Legal Business Name): ELIZABETH ANN PHILLIPS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2005
Last Update Date: 05/13/2021
Certification Date: 05/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 FLEMING LN
MINDEN LA
71055-3073
US

IV. Provider business mailing address

607 FLEMING LN
MINDEN LA
71055-3073
US

V. Phone/Fax

Practice location:
  • Phone: 318-371-2229
  • Fax: 318-371-2228
Mailing address:
  • Phone: 318-371-2229
  • Fax: 318-371-2228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number023825
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: