Basic Information
| Provider Information | |||||||||
| NPI: | 1356784417 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PHILIPS | ||||||||
| FirstName: | MARY | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 909 FROSTWOOD DR STE 1.100 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770242301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7133385519 | ||||||||
| FaxNumber: | 7137043086 | ||||||||
| Practice Location | |||||||||
| Address1: | 921 GESSNER RD FL 8 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770242501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7132423768 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2013 | ||||||||
| LastUpdateDate: | 07/21/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | R0104 | TX | N | Allopathic & Osteopathic Physicians | Family Medicine | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208M00000X | R0104 | TX | Y | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.