Provider Demographics
NPI:1518785906
Name:PHILLIPS, TIMOTHY RAY
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:RAY
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2251 MYRTLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75232-1039
Mailing Address - Country:US
Mailing Address - Phone:214-918-5938
Mailing Address - Fax:
Practice Address - Street 1:2251 MYRTLEWOOD DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75232-1039
Practice Address - Country:US
Practice Address - Phone:214-918-5938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty