Provider Demographics
NPI:1972704922
Name:DAY, PHILIP LYNN
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:LYNN
Last Name:DAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 JEALOUSE WAY STE 119
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-2578
Mailing Address - Country:US
Mailing Address - Phone:972-291-9044
Mailing Address - Fax:972-291-9440
Practice Address - Street 1:625 JEALOUSE WAY STE 119
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-2578
Practice Address - Country:US
Practice Address - Phone:972-291-9044
Practice Address - Fax:972-291-9440
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0094936332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0094936OtherLICENSE
6003020001Medicare NSC