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General NPI Number Information
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NPI Number | 1821050568
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Entity Type | Organization
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Legal Business Name | THERESA S. PHILLIPS, MD, PA
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Dates
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Enumeration Date | 04/06/2006
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Last Update Date | 07/10/2008
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Provider Practice Location Address
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Address Line | 710 WATER ST #602
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City | KERRVILLE
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State | TX
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Zip | 78028-5329
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Country | US
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Telephone | 830-257-1785
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Fax | 830-257-1786
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Provider Business Mailing Address
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Address Line | PO BOX 293279
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City | KERRVILLE
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State | TX
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Zip | 78029-3279
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Country | US
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Telephone | 830-257-1785
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Fax | 830-257-1786
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Authorized Official
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Title or Position | OWNER
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Name | THERESA S PHILLIPS
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Credential | MD
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Telephone | 830-257-1785
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | J8714
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License Number State | TX
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