Phillip Blevins, M.D.
Individual provider Active NPI Plastic Surgery Physician · Jackson, MS
NPI 1619907045 · NPPES record last updated Jun 13, 2012
Key facts
- NPI
- 1619907045
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Plastic Surgery Physician 208200000X
- License
- 07405 (MS)
- Practice address
- 2500 N State St
Jackson, MS 39216-4500 - Phone
- (601) 984-5180
- Fax
- (601) 984-5183
- NPI assigned
- Jul 3, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 07405 | MS | MD | Surgery of the Hand (Plastic Surgery) Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| University Radiation Oncology Consultants, PLLC | Past | Accepting new patients | |
| Plastic & Hand Surgery Associates PLLC | Plastic Surgery | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Plastic Surgery Physician | 208200000X | 07405 | MS | Yes |
| Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician | 2082S0099X | 07405 | MS | |
| Surgery of the Hand (Plastic Surgery) Physician | 2082S0105X | 07405 | MS |
Addresses
Primary practice location
2500 N State St
Jackson, MS 39216-4500
Mailing address
PO Box 24146
Jackson, MS 39225-4146
Phone (601) 984-5180
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00012332 | Medicaid | MS |
Other providers in Jackson, MS
- Kailin Danielle Blanton
- Betty Ann Blasi
- Blessings Beyond
- Blessings Beyond
- Wendy Nicole Blethen
- Tasha Blevins
- Lauren Smythe Bloodworth
- Bloom Health Services for Women
- Philip J Blount
- Blue Skyz Still Waters
All providers in Jackson, MS · Plastic Surgery Physician in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 13, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.