Provider Demographics
NPI:1912915976
Name:PHILLIPS, DONALD HARDY (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:HARDY
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-2619
Mailing Address - Country:US
Mailing Address - Phone:469-272-5444
Mailing Address - Fax:469-272-5456
Practice Address - Street 1:105 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-2619
Practice Address - Country:US
Practice Address - Phone:469-272-5444
Practice Address - Fax:469-272-5456
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2687207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE02239Medicare UPIN