Provider Demographics
NPI:1629651120
Name:QU, PHILLIP YUANLIN (MD)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:YUANLIN
Last Name:QU
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:104 BRIDGEWATER XING
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-8603
Mailing Address - Country:US
Mailing Address - Phone:601-940-5128
Mailing Address - Fax:
Practice Address - Street 1:2208 UNIVERSITY BLVD STE 101
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-2313
Practice Address - Country:US
Practice Address - Phone:205-933-2625
Practice Address - Fax:205-558-2567
Is Sole Proprietor?:No
Enumeration Date:2021-05-03
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MST-4450207W00000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology