Provider Demographics
NPI:1952388308
Name:PHINNEY, RICHARD BLAIR (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:BLAIR
Last Name:PHINNEY
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 1:2170 MIDLAND RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387-2927
Mailing Address - Country:US
Mailing Address - Phone:910-295-2100
Mailing Address - Fax:910-295-5339
Practice Address - Street 1:2170 MIDLAND RD
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-2927
Practice Address - Country:US
Practice Address - Phone:910-295-2100
Practice Address - Fax:910-295-5339
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-082190207W00000X
IA27985207W00000X
NC2016-00709207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0078956Medicaid
IL036082190Medicaid
IA26568OtherIA GROUP MEDICARE
IA0060350OtherIA GROUP MEDICAID
IL790730OtherIL GROUP MEDICARE