MR. DERALD PHILLIPS JR. (NPI# 1972083137) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1972083137 |
| Entity Type | Individual |
| Full Name | MR. DERALD PHILLIPS JR. |
| Credential | PA |
| Practice Address |
1901 Medi Park Dr Ste 2050 Amarillo TX 79106-2109 |
| Mailing Address |
3605 Portland Ave Amarillo TX 79118-8197 |
| Practice Telephone | 8063553352 |
| Mailing Telephone | 2179180207 |
| Enumeration Date | 2018-08-17 |
| Last Update Date | 2019-05-15 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
PA12454 | TX | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363AM0700X |
Physician Assistant Specialization: Medical |
Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
1901 MEDI PARK DR STE 2050 |
| City | AMARILLO |
| State | TX |
| Zip Code | 79106-2109 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831103241 | Arouj A Hashmi | Radiology | 1901 Medi Park Dr Ste 2050, Amarillo, TX 79106-2109 | 2006-07-28 |
| 1568820645 | Samuel L Pittman | Physician Assistant | 1901 Medi Park Dr Ste 2050, Amarillo, TX 79106-2109 | 2016-02-04 |
| 1053757724 | Nilay Virendrakumar Mehta | Radiology | 1901 Medi Park Dr Ste 2050, Amarillo, TX 79106 | 2013-05-21 |
| 1588940753 | Alejandro Malacara | Physician Assistant | 1901 Medi Park Dr Ste 2050, Amarillo, TX 79106-2109 | 2011-11-01 |
| 1609165000 | Toby Joe Truby | Radiology Practitioner Assistant | 1901 Medi Park Dr Ste 2050, Amarillo, TX 79106-2109 | 2011-04-06 |
| 1770872848 | Jon S Grubbs | Radiology Practitioner Assistant | 1901 Medi Park Dr Ste 2050, Amarillo, TX 79106-2109 | 2011-03-29 |
| 1699093831 | Paul Fereidon Hakim | Radiology | 1901 Medi Park Dr Ste 2050, Amarillo, TX 79106-2109 | 2010-05-12 |
| 1164657490 | Arturo Lira | Radiology | 1901 Medi Park Dr Ste 2050, Amarillo, TX 79106-2109 | 2009-05-15 |
| 1952500258 | April Alexander Bailey | Radiology | 1901 Medi Park Dr Ste 2050, Amarillo, TX 79106 | 2007-07-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538773205 | Nisha Patel | Pharmacist | 1600 S Western Street, Amarillo, TX 79106 | 2020-09-01 |
| 1043851769 | Diana Moore | Pharmacist | 6010 Amarillo Blvd W (119), Amarillo, TX 79106 | 2019-10-03 |
| 1164988127 | Wade Family Services Pllc | Counselor | 1901 Medi Park Dr Suite 130, Amarillo, TX 79106 | 2019-02-14 |
| 1255802963 | Jennifer Cockrum | Hospitalist | Bsa Hospitalist, 1600 Wallace Blvd., Amarillo, TX 79106 | 2018-12-07 |
| 1346736691 | Denise Mills Donnell | Social Worker | 6010 Amarillo Bouldevard West Clc-b, Amarillo, TX 79106 | 2018-07-10 |
| 1124525472 | Abigail Batson | Student in an Organized Health Care Education/Training Program | 1400 S Coulter Street, Suite 1500, Amarillo, TX 79106 | 2018-04-11 |
| 1053812743 | Moc Amarillo, LLC | Skilled Nursing Facility | 1540 Research St., Amarillo, TX 79106 | 2018-02-27 |
| 1013459437 | Larry G. Schulz | Durable Medical Equipment & Medical Supplies | 1901 Medi Park Dr Ste 219, Amarillo, TX 79106 | 2016-11-16 |
| 1922453315 | Omar Saeed M Alzhrani | Student in an Organized Health Care Education/Training Program | 1400 S. Coulter - Suite 5100, Amarillo, TX 79106 | 2016-05-04 |
| 1972967529 | David Wayne Hohon | Internal Medicine | Bsa Physician Group, 1600 Wallace Blvd., Amarillo, TX 79106 | 2016-04-11 |
| Find all providers in zip 79106 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881766970 | Victoria Grace Wilkinson | Physician Assistant | 1301 S Coulter St Ste 201, Amarillo, TX 79106-1765 | 2006-11-14 |
| 1245279173 | Robert Alan Murphey | Physician Assistant | 24 Care Circle, Amarillo, TX 79124-2118 | 2006-06-06 |
| 1053359778 | Tonia Hudson | Physician Assistant | 3440 Bell St Unit 122, Amarillo, TX 79119 | 2006-06-03 |
| 1467795625 | Behnoush Jaberian Doraji | Physician Assistant | 3440 Bell St Unit 122, Amarillo, TX 79109-4100 | 2013-04-05 |
| 1902106420 | Brittany G Tate | Physician Assistant | 1400 S Coulter St, Amarillo, TX 79106-1786 | 2010-11-01 |
| 1629389234 | Kristen M Rice | Physician Assistant | 4510 Bell St, Amarillo, TX 79109-5714 | 2010-06-29 |
| 1336466101 | Piper E Lockett | Physician Assistant | 1301 S Coulter St, Suite 413, Amarillo, TX 79106-1763 | 2010-05-03 |
| 1073849238 | Lisa Dawn Snow | Physician Assistant | 1901 Medi Park Dr, Bldg D Suite 2051, Amarillo, TX 79106-2110 | 2009-10-22 |
| 1275762874 | Jeremy Allen Parker | Physician Assistant | 1900 Medi Park Dr, Amarillo, TX 79106-2187 | 2009-07-06 |
| 1578634424 | Amber Soto | Physician Assistant | 6200 I-40 W, Amarillo, TX 79106-2512 | 2006-11-13 |
| Find all providers in AMARILLO | ||||
Please comment or provide details below to improve the information on MR. DERALD PHILLIPS JR..
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.