Provider Demographics
NPI:1841835915
Name:TINA J. PHILIP, D.O. PLLC
Entity type:Organization
Organization Name:TINA J. PHILIP, D.O. PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILIP
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:512-388-0511
Mailing Address - Street 1:511 OAKWOOD BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-4068
Mailing Address - Country:US
Mailing Address - Phone:512-388-0511
Mailing Address - Fax:
Practice Address - Street 1:511 OAKWOOD BLVD STE 202
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-4068
Practice Address - Country:US
Practice Address - Phone:512-388-0511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-13
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty