Provider Demographics
NPI:1063483121
Name:PHIRIPES, CONSTANTINE (MD)
Entity Type:Individual
Prefix:
First Name:CONSTANTINE
Middle Name:
Last Name:PHIRIPES
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:PO BOX 746079
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6079
Mailing Address - Country:US
Mailing Address - Phone:312-733-9730
Mailing Address - Fax:773-866-8014
Practice Address - Street 1:4115 E LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76103-3614
Practice Address - Country:US
Practice Address - Phone:817-796-7370
Practice Address - Fax:817-764-0714
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS7117207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA942497568OtherBLUE SHIELD
CAZZZ38477ZOtherMEDICARE GROUP ID
CA00G56470OtherBLUE CROSS
CA00G56470OtherUNITED HEALTHCARE
CA00G56470OtherAETNA
CA942497568OtherBLUE CROSS
CAGR0066340Medicaid
CA00G56470OtherBLUE SHIELD
CAGR0006345Medicaid
CA942497568OtherBLUE CROSS
CAF26865Medicare UPIN
CAGR0006345Medicaid