Healthcare Provider Details

I. General information

NPI: 1871633768
Provider Name (Legal Business Name): DAN M PHILLIPS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 04/10/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 US 1 HWY STE A
YOUNGSVILLE NC
27596-7847
US

IV. Provider business mailing address

464 SHADY OAK RD
ROXBORO NC
27574-9051
US

V. Phone/Fax

Practice location:
  • Phone: 919-679-1880
  • Fax: 800-507-0902
Mailing address:
  • Phone: 336-322-4333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number39060
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: