Provider Demographics
NPI:1922201094
Name:PHILLIPS, DAVID JASON (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JASON
Last Name:PHILLIPS
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 1:700 OLYMPIC PLAZA CIR
Mailing Address - Street 2:STE 602
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-1954
Mailing Address - Country:US
Mailing Address - Phone:903-593-2468
Mailing Address - Fax:903-592-5692
Practice Address - Street 1:515 W MAYFIELD RD STE 200
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76014-4596
Practice Address - Country:US
Practice Address - Phone:817-465-7868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN2731207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology