Provider Demographics
NPI:1962440685
Name:RILEY, PHILIP MICHAEL (DO)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:MICHAEL
Last Name:RILEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2708 RIFE MEDICAL LANE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-1452
Mailing Address - Country:US
Mailing Address - Phone:479-338-4400
Mailing Address - Fax:479-338-4445
Practice Address - Street 1:2708 RIFE MEDICAL LANE
Practice Address - Street 2:SUITE 220
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-1452
Practice Address - Country:US
Practice Address - Phone:479-338-4400
Practice Address - Fax:479-338-4445
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-5076207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR165590003Medicaid
AR5N848Medicare PIN