Provider Demographics
NPI:1962478719
Name:PHILIPPS, JAMES (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:PHILIPPS
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 5500
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79704-5500
Mailing Address - Country:US
Mailing Address - Phone:432-570-1421
Mailing Address - Fax:432-570-1427
Practice Address - Street 1:2200 W ILLINOIS AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-6407
Practice Address - Country:US
Practice Address - Phone:432-570-1421
Practice Address - Fax:432-570-1427
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL05092085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8Z0349OtherSWMI BCBS PROV #
TXA022OtherSWMI TRICARE PROV #
TX89130RMedicare PIN
TX8Z0349OtherSWMI BCBS PROV #