Provider Demographics
NPI:1548359771
Name:PHILIP, ANNE V (MD)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:V
Last Name:PHILIP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:
Other - Last Name:PHILIP
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2100 N MAIN ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76164-8570
Mailing Address - Country:US
Mailing Address - Phone:817-625-4254
Mailing Address - Fax:817-740-8612
Practice Address - Street 1:2106 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76164-8511
Practice Address - Country:US
Practice Address - Phone:817-625-4254
Practice Address - Fax:817-740-8612
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9783207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX046176603Medicaid
TX8CU552OtherBCBS
TXG24282Medicare UPIN
TXTXB129201Medicare PIN