Healthcare Provider Details

I. General information

NPI: 1477514800
Provider Name (Legal Business Name): PHILLIP A CONLIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 02/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 W. ILLINOIS AVE
MIDLAND TX
79701
US

IV. Provider business mailing address

PO BOX 8146
TYLER TX
75711-8146
US

V. Phone/Fax

Practice location:
  • Phone: 432-685-1111
  • Fax: 432-683-2616
Mailing address:
  • Phone: 800-288-8325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberL2850
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number20744
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: