# EBO MD OF POPLAR BLUFF LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1770152035
- **Authorized official:** MR. PHILIP JAMES CROCKER (CFO)
- **Authorized official phone:** (573) 686-5510

## Contact information

- **Practice address:** 2725 N WESTWOOD BLVD, POPLAR BLUFF, MO 63901-2346
- **Practice address phone:** (573) 686-5510
- **Mailing address:** 2725 N WESTWOOD BLVD STE 14, POPLAR BLUFF, MO 63901-2367
- **Mailing address phone:** (573) 686-5510

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/22/2021
- **Last updated:** 07/26/2021