Provider Demographics
NPI:1104885953
Name:PHILLIPS, CYNTHIA B (DO)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:B
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 269092
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-9092
Mailing Address - Country:US
Mailing Address - Phone:832-932-5138
Mailing Address - Fax:832-932-5142
Practice Address - Street 1:450 MEDICAL CENTER BLVD
Practice Address - Street 2:SUITE 540
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4234
Practice Address - Country:US
Practice Address - Phone:832-932-5138
Practice Address - Fax:832-932-5142
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0510207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8V1890OtherBCBS INDIV PROVIDER #
TX179225101Medicaid