Basic Information
| Provider Information | |||||||||
| NPI: | 1033185459 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PHIFER | ||||||||
| FirstName: | SYLVESTER | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1837 PASEO REAL CIR | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799363722 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9155499005 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10301 GATEWAY BLVD W | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799257701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9155359275 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/25/2006 | ||||||||
| LastUpdateDate: | 04/13/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | E8109 | TX | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 89013 | 01 | TX | AMERIGROUP | OTHER | GH05820081 | 01 | TX | EL PASO FIRST GROUP | OTHER | 85611Y | 01 | TX | BCBS | OTHER | CH05820081 | 01 | TX | EL PASO FIRST CHIPS | OTHER | 300107925 | 01 | TX | MEDICARE RR | OTHER | 742939272 | 01 | TX | TAX ID | OTHER | MDE8109TX | 01 | TX | WORKERS COMP | OTHER | 100819 | 01 | TX | SUPERIOR SSI | OTHER | 00F2883 | 01 | TX | MEDICAID NEWMEXICO | OTHER | 131754702 | 05 | TX | MEDICAID | 201012760 | 01 | TX | MEDICAID PRESBYTERIAN | OTHER |