Individual
ELBERT STINSON TILLERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1125 MADISON ST., JEFFERSON CITY, MO 65102-1128
(573) 635-7651
(573) 659-4515
Mailing address
1125 MADISON ST., JEFFERSON CITY, MO 65102-1128
(573) 635-7651
(573) 659-4515
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
2011041481
MO
208M00000X
Hospitalist Physician
Primary
2011041481
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
054133
LICENSE
GA
05
—
1003872714
—
MO
01
—
23919
1
SC
Enumeration date
04/21/2006
Last updated
01/15/2013
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