Basic Information
| Provider Information | |||||||||
| NPI: | 1780151076 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PHILIP | ||||||||
| FirstName: | DENNY | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 602 HUGH WALKER DR | ||||||||
| Address2: | |||||||||
| City: | MESQUITE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 751492696 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2144759609 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2001 INWOOD RD FL 6 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 753907202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2146458898 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2018 | ||||||||
| LastUpdateDate: | 10/25/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.