Provider Demographics
NPI:1548524424
Name:PHILIP, JISSY RACHEL (DO)
Entity type:Individual
Prefix:DR
First Name:JISSY
Middle Name:RACHEL
Last Name:PHILIP
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:JISSY
Other - Middle Name:RACHEL
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:7217 TELECOM PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75044-2203
Mailing Address - Country:US
Mailing Address - Phone:469-800-2100
Mailing Address - Fax:469-800-2310
Practice Address - Street 1:7217 TELECOM PKWY STE 100
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75044-2203
Practice Address - Country:US
Practice Address - Phone:469-800-2100
Practice Address - Fax:469-800-2310
Is Sole Proprietor?:No
Enumeration Date:2012-06-26
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0116025050207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine