Provider Demographics
NPI:1760478390
Name:PHILLIPS, PAULA JANE (MD)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:JANE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7155 OLD KATY RD
Mailing Address - Street 2:N100
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2134
Mailing Address - Country:US
Mailing Address - Phone:713-668-6828
Mailing Address - Fax:832-280-3636
Practice Address - Street 1:1229 CAMPBELL RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-6401
Practice Address - Country:US
Practice Address - Phone:713-467-6600
Practice Address - Fax:713-467-7914
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXG8341207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1394140Medicaid
C20494Medicare UPIN
TX88092JMedicare PIN