MEDICARE: GREGORY PHILLIPS

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
1	207R00000X	Internal Medicine Physician	F5328	TX

General Provider Information

NPI Number	:	1720414881
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREGORY PHILLIPS

Provider Business Mailing Address
First Line	:	724 PENNSYLVANIA AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-2221
Country	:	US
Telephone Number	:	817-336-1200
Fax Number	:	817-338-4707

Provider Business Practice Location Address
First Line	:	724 PENNSYLVANIA AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-2221
Country	:	US
Telephone Number	:	817-336-1200
Fax Number	:	817-338-4707

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GREGORY JOSEPH PHILLIPS
Credential	:	M.D.
Telephone Number	:	817-336-1200

Provider Enumeration Date	:	09/20/2013
Last Update Date	:	04/16/2014

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