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General NPI Number Information
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NPI Number | 1629651120
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Entity Type | Individual
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Provider Name | PHILLIP YUANLIN QU MD
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Gender | Male
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Dates
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Enumeration Date | 05/03/2021
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Last Update Date | 05/21/2025
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Provider Practice Location Address
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Address Line | 2208 UNIVERSITY BLVD STE 101
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City | BIRMINGHAM
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State | AL
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Zip | 35233-2313
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Country | US
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Telephone | 205-933-2625
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Fax | 205-558-2567
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Provider Business Mailing Address
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Address Line | 104 BRIDGEWATER XING
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City | RIDGELAND
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State | MS
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Zip | 39157-8603
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Country | US
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Telephone | 601-940-5128
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | T-4450
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License Number State | MS
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