Basic Information
| Provider Information | |||||||||
| NPI: | 1417275363 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PHILLIPS | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | DAVID | ||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4106 JOHN STOCKBAUER DR | ||||||||
| Address2: | APT 122 | ||||||||
| City: | VICTORIA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 779041922 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2818136106 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1501 E MOCKINGBIRD LN STE 220 | ||||||||
| Address2: | VICTORIA ANESTHESIOLOGY ASSOCIATES | ||||||||
| City: | VICTORIA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 779042194 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3615732481 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2010 | ||||||||
| LastUpdateDate: | 10/12/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | BP10037939 | TX | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.