Provider Demographics
NPI:1770787426
Name:PHIPPS, MYRA AURELIA (MD)
Entity type:Individual
Prefix:DR
First Name:MYRA
Middle Name:AURELIA
Last Name:PHIPPS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:201 FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-4311
Mailing Address - Country:US
Mailing Address - Phone:864-855-0853
Mailing Address - Fax:864-855-5882
Practice Address - Street 1:303 DACUSVILLE HWY
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29640-1510
Practice Address - Country:US
Practice Address - Phone:864-855-0853
Practice Address - Fax:864-855-5882
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC20402207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine