Phillips, Timothy Martin

Phillips, Timothy Martin is an individual health care provider with primary practice located at 1465 S Grand Blvd , Saint Louis MO 63104-1003. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatric Urology, which is considered as his primary health care specialty. Phillips, Timothy Martin can be contacted via phone (210) 857-4174.

Contact Information

Primary practice address
1465 S Grand Blvd Saint Louis MO 63104-1003
Phone: (210) 857-4174
Fax: (314) 268-4176
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatric Urology 2088P0231X N6582 Texas
Allopathic & Osteopathic Physicians / Pediatric Urology 2088P0231X 2018010765 Missouri

Profile Details

NPI number 1992724595
LBN Legal business name Phillips, Timothy Martin
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 18th, 2006
Last updated Jan 15th, 2021 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1992724595 NPPES
Texas MEDICAID 286858001

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