Provider Demographics
NPI:1144260704
Name:PHILLIPS, ELIZABETH LEWIS (MD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:LEWIS
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 E PINE ST APT 1621
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-6628
Mailing Address - Country:US
Mailing Address - Phone:205-613-0860
Mailing Address - Fax:
Practice Address - Street 1:415 E PINE ST APT 1621
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32801-6628
Practice Address - Country:US
Practice Address - Phone:205-613-0860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN37672207P00000X
KY47364207P00000X
ALMD.22988207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009913013Medicaid
TN3886731Medicaid
AL009913632Medicaid
AL515-44826OtherBCBS
KY7100535310Medicaid
AL1144260704OtherTRICARE SOUTH
AL515-44828OtherBCBS
AL510I930055Medicare PIN
AL1144260704OtherTRICARE SOUTH
TN3886731Medicare ID - Type Unspecified
AL009913632Medicaid
AL510I930051Medicare PIN