Provider Demographics
NPI:1972957017
Name:PHILIP, JUSTUS VARGHESE (MD)
Entity Type:Individual
Prefix:DR
First Name:JUSTUS
Middle Name:VARGHESE
Last Name:PHILIP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4201 BROWN TRL STE 101
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-3941
Mailing Address - Country:US
Mailing Address - Phone:862-217-2102
Mailing Address - Fax:833-396-2418
Practice Address - Street 1:4201 BROWN TRL STE 101
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-3941
Practice Address - Country:US
Practice Address - Phone:862-217-2102
Practice Address - Fax:833-396-2418
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-14
Last Update Date:2022-09-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXT8627208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty