Provider Demographics
NPI:1447210620
Name:PHIPPS, JOHN D (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:PHIPPS
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:PO BOX 751803
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1803
Mailing Address - Country:US
Mailing Address - Phone:336-765-0020
Mailing Address - Fax:336-765-0581
Practice Address - Street 1:105 VEST MILL CIR
Practice Address - Street 2:SUITE 201
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-2943
Practice Address - Country:US
Practice Address - Phone:336-718-7800
Practice Address - Fax:336-718-7900
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9501058207RE0101X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA10156424Medicaid
NC891139AMedicaid
VA10156424Medicaid
NC2251518AMedicare PIN
G69881Medicare UPIN