Individual
BENNIE N TILL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
686 LESTER ST, POPLAR BLUFF, MO 63901-5025
(573) 686-2411
(573) 686-8452
Mailing address
PO BOX 220, POPLAR BLUFF, MO 63902-0220
(573) 686-2411
(573) 686-8452
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
29706
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080037689
TRAVELERS MEDICARE
—
05
—
108014001
—
AR
05
—
200421709
—
MO
Enumeration date
01/11/2006
Last updated
09/01/2011
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