Provider Demographics
NPI:1851377972
Name:PHILLIPS, JAMES K JR (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:K
Last Name:PHILLIPS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1777 ASHLEY CIRCLE
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-3339
Mailing Address - Country:US
Mailing Address - Phone:270-781-4090
Mailing Address - Fax:270-842-3133
Practice Address - Street 1:1777 ASHLEY CIR
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-3339
Practice Address - Country:US
Practice Address - Phone:270-781-4090
Practice Address - Fax:270-842-3133
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-20
Last Update Date:2017-07-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY18154207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYCH4189OtherRAILROAD MEDICARE
KY611356450OtherTAX ID#
KY0000053948OtherBLUE CROSS BLUE SHIELD
KYC73850Medicare UPIN
KYCH4189OtherRAILROAD MEDICARE
C73850Medicare UPIN
6231Medicare PIN