Healthcare Provider Details

I. General information

NPI: 1518276252
Provider Name (Legal Business Name): CURTIS PHILLIPS DO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2010
Last Update Date: 09/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

428 S WILSON ST
VINITA OK
74301-4246
US

IV. Provider business mailing address

PO BOX 439
VINITA OK
74301-0439
US

V. Phone/Fax

Practice location:
  • Phone: 918-256-5021
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number3379
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number3379
License Number StateOH

VIII. Authorized Official

Name: CURTIS PHILLIPS
Title or Position: OWNER
Credential: DO
Phone: 918-256-5021