Provider Demographics
NPI:1013983774
Name:PHILLIPS, JOSEPH THEODORE JR (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:THEODORE
Last Name:PHILLIPS
Suffix:JR
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 1:6301 GASTON AVE
Mailing Address - Street 2:SUITE 100 WEST TOWER
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-3922
Mailing Address - Country:US
Mailing Address - Phone:214-827-3610
Mailing Address - Fax:214-443-9640
Practice Address - Street 1:6301 GASTON AVE
Practice Address - Street 2:SUITE 100 WEST TOWER
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75214-3922
Practice Address - Country:US
Practice Address - Phone:214-827-3610
Practice Address - Fax:214-443-9640
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF99512084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX123466802Medicaid
TXE09223Medicare UPIN
TX123466802Medicaid