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Organization
EBO MD OF POPLAR BLUFF LLC
Active
Organization
EBO MD OF POPLAR BLUFF LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PHILIP JAMES CROCKER (CFO)
(573) 686-5510
Entity
Organization
Contact information
Practice address
2725 N WESTWOOD BLVD, POPLAR BLUFF, MO 63901-2346
(573) 686-5510
Mailing address
2725 N WESTWOOD BLVD STE 14, POPLAR BLUFF, MO 63901-2367
(573) 686-5510
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
06/22/2021
Last updated
07/26/2021
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