Provider Demographics
NPI:1770559403
Name:PHILLIPS, JOHN D (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:521 MARSHALL RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72076-3749
Mailing Address - Country:US
Mailing Address - Phone:501-985-0616
Mailing Address - Fax:501-985-0715
Practice Address - Street 1:521 MARSHALL RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72076-3749
Practice Address - Country:US
Practice Address - Phone:501-985-0616
Practice Address - Fax:501-985-0715
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARE0219207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR131644001Medicaid
AR5K443Medicare ID - Type Unspecified
AR131644001Medicaid