Healthcare Provider Details

I. General information

NPI: 1497813976
Provider Name (Legal Business Name): DANIEL PHILLIPS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 05/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14825 N OUTER 40 SUITE 330
CHESTERFIELD MO
63017-2152
US

IV. Provider business mailing address

PO BOX 958874
SAINT LOUIS MO
63195-8874
US

V. Phone/Fax

Practice location:
  • Phone: 636-537-0525
  • Fax: 636-537-0575
Mailing address:
  • Phone: 636-537-0525
  • Fax: 636-537-0575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberR9B29
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: