Provider Demographics
NPI:1275531303
Name:PHILLIPS, ROBERT D (MD)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
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 1:437 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-2982
Mailing Address - Country:US
Mailing Address - Phone:615-452-8705
Mailing Address - Fax:615-452-8740
Practice Address - Street 1:437 E MAIN ST
Practice Address - Street 2:
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-2982
Practice Address - Country:US
Practice Address - Phone:615-452-8705
Practice Address - Fax:615-452-8740
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN027255207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3096024Medicaid
A41648Medicare UPIN
TN3096024Medicare ID - Type Unspecified