Provider Demographics
NPI:1649269564
Name:PHILLIPS, ELIZABETH ANN (MD)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ANN
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 FLEMING LN
Mailing Address - Street 2:
Mailing Address - City:MINDEN
Mailing Address - State:LA
Mailing Address - Zip Code:71055-3073
Mailing Address - Country:US
Mailing Address - Phone:318-371-2229
Mailing Address - Fax:318-371-2228
Practice Address - Street 1:607 FLEMING LN
Practice Address - Street 2:
Practice Address - City:MINDEN
Practice Address - State:LA
Practice Address - Zip Code:71055-3073
Practice Address - Country:US
Practice Address - Phone:318-371-2229
Practice Address - Fax:318-371-2228
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA023825208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1537683Medicaid