Provider Demographics
NPI:1174571749
Name:BALLINGER, PHILLIP SCOTT (MD)
Entity type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:SCOTT
Last Name:BALLINGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 9662
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72033-9662
Mailing Address - Country:US
Mailing Address - Phone:501-852-1363
Mailing Address - Fax:501-852-1364
Practice Address - Street 1:525 WESTERN AVE STE 302A
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-4981
Practice Address - Country:US
Practice Address - Phone:501-205-8095
Practice Address - Fax:501-205-8533
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE34925207Y00000X
ALMD.34694207Y00000X
ARE2157207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology