Provider Demographics
NPI:1124021571
Name:PHILLIPS, BARRY S (MD)
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:S
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:MD
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 1510
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47706-1510
Mailing Address - Country:US
Mailing Address - Phone:812-853-5300
Mailing Address - Fax:812-858-4660
Practice Address - Street 1:4111 GATEWAY BLVD
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-8954
Practice Address - Country:US
Practice Address - Phone:812-853-5300
Practice Address - Fax:812-858-4660
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01044946A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200095900Medicaid
IN000000067636OtherBCBS PIN
IN191410AMedicare ID - Type Unspecified
IN000000067636OtherBCBS PIN
ING24639Medicare UPIN