Provider Demographics
NPI:1073501219
Name:PHILLIPS, CHRISTOPHER D (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:D
Last Name:PHILLIPS
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 1:6555 PERKINS RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4237
Mailing Address - Country:US
Mailing Address - Phone:225-810-3342
Mailing Address - Fax:225-810-3348
Practice Address - Street 1:6555 PERKINS RD
Practice Address - Street 2:SUITE 300
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4237
Practice Address - Country:US
Practice Address - Phone:225-810-3342
Practice Address - Fax:225-810-3348
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-12
Last Update Date:2012-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD2020752084N0400X
NY2176912084N0400X
MDD509462084N0400X
NMMD2012-05602084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4N249DH71Medicare PIN
H96203Medicare UPIN