Provider Demographics
NPI:1912993593
Name:PHILLIPS, STEPHEN L JR (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:L
Last Name:PHILLIPS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1901 STONEHENGE DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-5067
Mailing Address - Country:US
Mailing Address - Phone:252-561-7777
Mailing Address - Fax:252-561-7778
Practice Address - Street 1:1901 STONEHENGE DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5067
Practice Address - Country:US
Practice Address - Phone:252-561-7777
Practice Address - Fax:252-561-7778
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2023-10-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC9700362208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC10383OtherBCBS NC
NC8910383Medicaid
NC2237574AMedicare ID - Type Unspecified
NC10383OtherBCBS NC