Provider Demographics
NPI:1770348526
Name:PIPER, PHILLIP ALLEN
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:ALLEN
Last Name:PIPER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2205 WILLIAMS TRACE BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-4443
Mailing Address - Country:US
Mailing Address - Phone:832-303-2333
Mailing Address - Fax:
Practice Address - Street 1:615 REVA RIDGE DR
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-6335
Practice Address - Country:US
Practice Address - Phone:832-372-8246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-20
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16789656251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management