Provider Demographics
NPI:1326047341
Name:PITTS, PHILIP W (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:W
Last Name:PITTS
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 1:425 N HIGHLAND AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092-7383
Mailing Address - Country:US
Mailing Address - Phone:903-892-8112
Mailing Address - Fax:903-893-8637
Practice Address - Street 1:425 N HIGHLAND AVE STE 210
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-7383
Practice Address - Country:US
Practice Address - Phone:903-892-8112
Practice Address - Fax:903-893-8637
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-20
Last Update Date:2022-07-20
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-23
Provider Licenses
StateLicense IDTaxonomies
TXJ2901207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0047HLOtherBCBS OF TEXAS PROVIDER NO
TXJ2901OtherTX LICENSE #
TX039011404Medicaid
110235123OtherRAILROAD MEDICARE PIN
8760B0Medicare PIN
TX039011404Medicaid