Provider Demographics
NPI:1871561878
Name:PHILLIPS, HORACE BYRON (MD)
Entity type:Individual
Prefix:DR
First Name:HORACE
Middle Name:BYRON
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 1:724 STONE AVE
Mailing Address - Street 2:
Mailing Address - City:TALLADEGA
Mailing Address - State:AL
Mailing Address - Zip Code:35160-2219
Mailing Address - Country:US
Mailing Address - Phone:256-362-1410
Mailing Address - Fax:256-362-0186
Practice Address - Street 1:724 STONE AVE
Practice Address - Street 2:
Practice Address - City:TALLADEGA
Practice Address - State:AL
Practice Address - Zip Code:35160-2219
Practice Address - Country:US
Practice Address - Phone:256-362-1410
Practice Address - Fax:256-362-0186
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7778207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL45001Medicaid
AL45001Medicare ID - Type Unspecified
ALC78933Medicare UPIN