# MR. CHARLES R TILLEY JR.

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1467502286
- **Gender:** Man

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | 001775 | IA | Yes |
| 363A00000X | Physician Assistant | 1409 | NE | — |

## Other

- **Enumeration date:** 01/12/2007
- **Last updated:** 10/19/2022