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Individual

ROY JACK GILLISPIE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
5136 HWY 265, BRANSON, MO 65616-9099
(417) 338-0960
(417) 338-0968
Mailing address
5136 HWY 265, BRANSON, MO 65616-9099
(417) 338-0960
(417) 338-0968

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
R2A36
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
080192592
RAILROAD MEDICARE
05
201260536
MO
01
7500
BCBS
Enumeration date
06/16/2006
Last updated
05/01/2013
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