Provider Demographics
NPI:1003648692
Name:BIRDINE, PHILLIP MORRIS JR (LAB DIRECTOR)
Entity type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:MORRIS
Last Name:BIRDINE
Suffix:JR
Gender:M
Credentials:LAB DIRECTOR
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Mailing Address - Street 1:525 FORT WORTH DR STE 211
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-7179
Mailing Address - Country:US
Mailing Address - Phone:940-465-3822
Mailing Address - Fax:
Practice Address - Street 1:525 FORT WORTH DR STE 211
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-7179
Practice Address - Country:US
Practice Address - Phone:940-465-3822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX45D2308500291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory