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NPI Code Detail

MEDICARE: MR. DOUGLAS ANTHONY PHILLIPS CRNA

MEDICARE: MR. DOUGLAS ANTHONY PHILLIPS CRNA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367500000XCertified Registered Nurse AnesthetistRN162763GA

General Provider Information

NPI Number : 1134209398
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DOUGLAS ANTHONY PHILLIPS CRNA
Provider Business Mailing Address
First Line : 101 ROB ROY RD
Second Line :
City : SOUTHERN PINES
State : NC
Zip : 28387-7225
Country : US
Telephone Number : 912-980-5936
Fax Number :
Provider Business Practice Location Address
First Line : 2170 MIDLAND RD
Second Line :
City : SOUTHERN PINES
State : NC
Zip : 28387-2999
Country : US
Telephone Number : 910-295-2100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/16/2006
Last Update Date : 12/02/2025

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