Provider Demographics
NPI:1497743413
Name:PHILLIPS, GREGORY SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:SCOTT
Last Name:PHILLIPS
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 1:382 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SIBLEY
Mailing Address - State:LA
Mailing Address - Zip Code:71073-2985
Mailing Address - Country:US
Mailing Address - Phone:318-382-9401
Mailing Address - Fax:318-382-9403
Practice Address - Street 1:382 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SIBLEY
Practice Address - State:LA
Practice Address - Zip Code:71073-2985
Practice Address - Country:US
Practice Address - Phone:318-382-9401
Practice Address - Fax:318-382-9403
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-13
Last Update Date:2011-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA023191207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1495344Medicaid
G87553Medicare UPIN
LA5CR92Medicare PIN