Provider Demographics
NPI:1497744767
Name:PHY, MICHAEL P (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:P
Last Name:PHY
Suffix:
Gender:M
Credentials:DO
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 5865
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79408-5865
Mailing Address - Country:US
Mailing Address - Phone:806-743-3150
Mailing Address - Fax:806-743-3168
Practice Address - Street 1:3601 4TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79430-9410
Practice Address - Country:US
Practice Address - Phone:806-743-3150
Practice Address - Fax:806-743-3168
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5662207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100149890AMedicaid
NM68807Medicaid
NMA451OtherTRIWEST
NM66398Medicaid
NM68807OtherPRESBYTERIAN COMMERCIAL
TX84304ZOtherHMO BLUE
TX88178GOtherBC/BS
TX118516701Medicaid
TX121479101Medicaid
TX121479103OtherFIRSTCARE COMMERCIAL
NM66398Medicaid
OK100149890AMedicaid
TXG88511Medicare UPIN