Provider Demographics
NPI:1790742310
Name:PHILLIPS, RITA CATHY (MD)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:CATHY
Last Name:PHILLIPS
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 1:908 YUKON DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-6345
Mailing Address - Country:US
Mailing Address - Phone:214-450-5119
Mailing Address - Fax:
Practice Address - Street 1:908 YUKON DR
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-6345
Practice Address - Country:US
Practice Address - Phone:214-450-5119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3054207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX131490804Medicaid
E06993Medicare UPIN
TX84595NMedicare ID - Type Unspecified