Provider Demographics
NPI:1528011244
Name:LABOR, PHILLIPS KIRK (MD)
Entity Type:Individual
Prefix:
First Name:PHILLIPS
Middle Name:KIRK
Last Name:LABOR
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 1:2201 WESTGATE PLAZA
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051
Mailing Address - Country:US
Mailing Address - Phone:817-410-2030
Mailing Address - Fax:817-251-6261
Practice Address - Street 1:2201 WESTGATE PLAZA
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051
Practice Address - Country:US
Practice Address - Phone:817-410-2030
Practice Address - Fax:817-251-6261
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7044207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX15470333OtherPACIFICARE PIN
TX8A2214OtherBCBS PIN
TX5456201OtherAETNA PIN
TX3977274OtherCIGNA PIN
TXF35264Medicare UPIN
TX00535UMedicare ID - Type Unspecified