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General NPI Number Information
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NPI Number | 1225058266
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Entity Type | Individual
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Provider Name | LARRY C. PHILLIPS II P.A.C.
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Gender | Male
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Dates
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Enumeration Date | 07/20/2006
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Last Update Date | 05/13/2013
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Provider Practice Location Address
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Address Line | 441 E PINEY FOREST RD
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City | DANVILLE
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State | VA
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Zip | 24540
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Country | US
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Telephone | 434-791-4110
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Fax |
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Provider Business Mailing Address
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Address Line | 441 E PINEY FOREST RD
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City | DANVILLE
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State | VA
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Zip | 24540
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Country | US
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Telephone | 434-791-4110
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 102445
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 0110003402
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License Number State | VA
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