Provider Demographics
NPI:1356494868
Name:WARING, PHYLLIS DALE (MD)
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:DALE
Last Name:WARING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 RUE JONATHAN
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-5438
Mailing Address - Country:US
Mailing Address - Phone:985-847-0689
Mailing Address - Fax:
Practice Address - Street 1:204 RUE JONATHAN
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-5438
Practice Address - Country:US
Practice Address - Phone:985-847-0689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA017996208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics