=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104035781
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SCOTT BRIAN PHILLIPS M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/21/2007
-----------------------------------------------------
Last Update Date | 04/05/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1912 LOOP 11
-----------------------------------------------------
City | WICHITA FALLS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76306-4921
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 940-263-1551
-----------------------------------------------------
Fax | 833-620-2407
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1912 LOOP 11
-----------------------------------------------------
City | WICHITA FALLS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76306-4921
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 940-263-1551
-----------------------------------------------------
Fax | 833-620-2407
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207T00000X
-----------------------------------------------------
Taxonomy Name | Neurological Surgery Physician
-----------------------------------------------------
License Number | Q6976
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------