Provider Demographics
NPI:1154388874
Name:PHILLIPS, RONALD S (DO)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:S
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 ROPER CORNERS CIRCLE
Mailing Address - Street 2:PO BOX 24250
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29616-4250
Mailing Address - Country:US
Mailing Address - Phone:864-281-9999
Mailing Address - Fax:864-281-9990
Practice Address - Street 1:2 ROPER CORNERS CIRCLE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29616-4250
Practice Address - Country:US
Practice Address - Phone:864-281-9999
Practice Address - Fax:864-281-9990
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0342207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCF166946577Medicare UPIN