Provider Demographics
NPI:1326246836
Name:PHILLIPS, GABRIEL HOOPER (MD)
Entity Type:Individual
Prefix:DR
First Name:GABRIEL
Middle Name:HOOPER
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:920 DOUG WHITE DR STE 460
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29572-4182
Mailing Address - Country:US
Mailing Address - Phone:843-449-2336
Mailing Address - Fax:843-497-0625
Practice Address - Street 1:920 DOUG WHITE DR STE 460
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29572-4182
Practice Address - Country:US
Practice Address - Phone:843-449-2336
Practice Address - Fax:843-497-0625
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY46283207T00000X
SC85541207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100246050Medicaid
KYK092490Medicare PIN
KY0169Medicare PIN