Provider Demographics
NPI:1477870822
Name:PHILLIPS, CATHERINE DURST (DO)
Entity Type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:DURST
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:CATHERINE
Other - Middle Name:LOUISA
Other - Last Name:DURST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:2682 W OXFORD LOOP STE 130
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-5441
Mailing Address - Country:US
Mailing Address - Phone:662-371-1543
Mailing Address - Fax:662-371-1548
Practice Address - Street 1:2682 W OXFORD LOOP STE 130
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-5441
Practice Address - Country:US
Practice Address - Phone:662-371-1543
Practice Address - Fax:662-371-1548
Is Sole Proprietor?:No
Enumeration Date:2010-04-26
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MS22706208000000X
LADO.000337208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04225858Medicaid