Provider Demographics
NPI:1396073672
Name:RONALD PHILLEAUX M.D. P.A.
Entity type:Organization
Organization Name:RONALD PHILLEAUX M.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALDL
Authorized Official - Middle Name:WREYBURN
Authorized Official - Last Name:PHILLEAUX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-357-9481
Mailing Address - Street 1:10246 MIDWAY RD.
Mailing Address - Street 2:SUITE 105
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75229-6223
Mailing Address - Country:US
Mailing Address - Phone:214-357-9481
Mailing Address - Fax:214-902-0636
Practice Address - Street 1:10246 MIDWAY RD
Practice Address - Street 2:SUITE 105
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75229-6233
Practice Address - Country:US
Practice Address - Phone:214-357-9481
Practice Address - Fax:214-902-0636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-25
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD-1883305R00000X
TXD1883305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization