Provider Demographics
NPI:1265499693
Name:PHILLIPS, STEPHEN J (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:J
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:8609 MONTAGUE LN
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29588-4504
Mailing Address - Country:US
Mailing Address - Phone:843-215-3363
Mailing Address - Fax:843-215-7201
Practice Address - Street 1:8609 MONTAGUE LN
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29588-4504
Practice Address - Country:US
Practice Address - Phone:843-215-3363
Practice Address - Fax:843-215-7201
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-28
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC26821207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ00271Medicaid
SCH61075Medicare UPIN