Provider Demographics
NPI:1134126576
Name:PHILLIPS, CURTIS ALAN (DO)
Entity Type:Individual
Prefix:DR
First Name:CURTIS
Middle Name:ALAN
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:DO
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 439
Mailing Address - Street 2:
Mailing Address - City:VINITA
Mailing Address - State:OK
Mailing Address - Zip Code:74301-0439
Mailing Address - Country:US
Mailing Address - Phone:918-256-5021
Mailing Address - Fax:918-256-7036
Practice Address - Street 1:428 S WILSON ST
Practice Address - Street 2:
Practice Address - City:VINITA
Practice Address - State:OK
Practice Address - Zip Code:74301-4246
Practice Address - Country:US
Practice Address - Phone:918-256-5021
Practice Address - Fax:918-256-7036
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-30
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3379207Q00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100228370AMedicaid
OK100228370AMedicaid