Provider Demographics
NPI:1003088972
Name:CRACE, PHILLIP PARKER (MD FACS)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:PARKER
Last Name:CRACE
Suffix:
Gender:M
Credentials:MD FACS
Other - Prefix:
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Mailing Address - Street 1:204 SERIO BLVD
Mailing Address - Street 2:
Mailing Address - City:FERRIDAY
Mailing Address - State:LA
Mailing Address - Zip Code:71334
Mailing Address - Country:US
Mailing Address - Phone:318-757-8010
Mailing Address - Fax:318-757-9501
Practice Address - Street 1:204 SERIO BLVD
Practice Address - Street 2:
Practice Address - City:FERRIDAY
Practice Address - State:LA
Practice Address - Zip Code:71334
Practice Address - Country:US
Practice Address - Phone:318-757-8010
Practice Address - Fax:318-757-9501
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-31
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY41691208600000X
LAMD206664208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery