Provider Demographics
NPI:1558394965
Name:PHILIP, PRIYA M (MD)
Entity Type:Individual
Prefix:
First Name:PRIYA
Middle Name:M
Last Name:PHILIP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5205 TOPAZ CT
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75022-8143
Mailing Address - Country:US
Mailing Address - Phone:214-616-1967
Mailing Address - Fax:866-612-6169
Practice Address - Street 1:5205 TOPAZ CT
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75022-8143
Practice Address - Country:US
Practice Address - Phone:214-616-1967
Practice Address - Fax:833-633-6176
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2021-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5513207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX158254601Medicaid
TX158254601Medicaid
TX8A6306Medicare ID - Type Unspecified