MEDICARE: RICKY LAWTON PHILLIPS M.D.

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	207P00000X	Emergency Medicine Physician	00009483	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	051039541	OTHER	AL	BLUE CROSS/BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942262522
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICKY LAWTON PHILLIPS M.D.

Provider Business Mailing Address
First Line	:	1703 VESTWOOD HILLS DR
Second Line	:
City	:	VESTAVIA
State	:	AL
Zip	:	35216-1367
Country	:	US
Telephone Number	:	205-979-0051
Fax Number	:

Provider Business Practice Location Address
First Line	:	1703 VESTWOOD HILLS DR
Second Line	:
City	:	VESTAVIA
State	:	AL
Zip	:	35216-1367
Country	:	US
Telephone Number	:	205-979-0051
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2006
Last Update Date	:	11/20/2012

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