Provider Demographics
NPI:1558477455
Name:PHIPPS, RONNY GENE (MD)
Entity Type:Individual
Prefix:
First Name:RONNY
Middle Name:GENE
Last Name:PHIPPS
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:PO BOX 9159
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-9159
Mailing Address - Country:US
Mailing Address - Phone:479-795-2167
Mailing Address - Fax:479-795-2177
Practice Address - Street 1:331 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:CENTERTON
Practice Address - State:AR
Practice Address - Zip Code:72719
Practice Address - Country:US
Practice Address - Phone:479-795-2167
Practice Address - Fax:479-795-2177
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC5712207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR143748001Medicaid
OK100180180AMedicaid
MO1558477455Medicaid
B90973Medicare UPIN
AR143748001Medicaid
MO1558477455Medicaid