Provider Demographics
NPI:1033185459
Name:PHIFER, SYLVESTER D (MD)
Entity Type:Individual
Prefix:
First Name:SYLVESTER
Middle Name:D
Last Name:PHIFER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1837 PASEO REAL CIR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-3722
Mailing Address - Country:US
Mailing Address - Phone:915-549-9005
Mailing Address - Fax:
Practice Address - Street 1:10301 GATEWAY BLVD W
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-7701
Practice Address - Country:US
Practice Address - Phone:915-535-9275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-25
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE81092085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX89013OtherAMERIGROUP
TXGH05820081OtherEL PASO FIRST GROUP
TX85611YOtherBCBS
TXCH05820081OtherEL PASO FIRST CHIPS
TX300107925OtherMEDICARE RR
TX742939272OtherTAX ID
TXMDE8109TXOtherWORKERS COMP
TX100819OtherSUPERIOR SSI
TX00F2883OtherMEDICAID NEWMEXICO
TX131754702Medicaid
TX201012760OtherMEDICAID PRESBYTERIAN
TXCH05820081OtherEL PASO FIRST CHIPS
TXGH05820081OtherEL PASO FIRST GROUP