Individual
MR. EDDIE LYNN PAULK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
6812 STATE ROUTE 162 STE 21, MARYVILLE, IL 62062-8565
(618) 288-5566
(618) 288-4005
Mailing address
6810 STATE ROUTE 162 BOX 215, MARYVILLE, IL 62062-8501
(618) 391-6405
(618) 288-4088
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
R9H10
MO
208D00000X
General Practice Physician
R9H10
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
242830743
—
MO
Enumeration date
06/29/2005
Last updated
08/28/2024
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