Provider Demographics
NPI:1073510368
Name:PHILLIPS, LARRY EWING (MD)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:EWING
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 1:2503 HIGHWAY 281N
Mailing Address - Street 2:SUITE 400
Mailing Address - City:MARBLE FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:78654
Mailing Address - Country:US
Mailing Address - Phone:830-693-5889
Mailing Address - Fax:830-693-5801
Practice Address - Street 1:2503 HIGHWAY 281N
Practice Address - Street 2:SUITE 400
Practice Address - City:MARBLE FALLS
Practice Address - State:TX
Practice Address - Zip Code:78654
Practice Address - Country:US
Practice Address - Phone:830-693-5889
Practice Address - Fax:830-693-5801
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD6131208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC20500Medicare UPIN