Provider Demographics
NPI:1538352604
Name:PHILLIPS, PAUL ARTHUR (DO)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ARTHUR
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 284
Mailing Address - Street 2:
Mailing Address - City:DANTE
Mailing Address - State:VA
Mailing Address - Zip Code:24237-0284
Mailing Address - Country:US
Mailing Address - Phone:276-608-5684
Mailing Address - Fax:
Practice Address - Street 1:58 CARROLL STREET
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:VA
Practice Address - Zip Code:24266
Practice Address - Country:US
Practice Address - Phone:276-883-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1988207P00000X, 207Q00000X
VA0102202256207Q00000X, 207P00000X
TNDO1988207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3714470OtherGROUP MEDICARE
VA1538352604Medicaid
TN621052914073OtherTRICARE
TN3714470OtherGROUP MEDICARE