Individual
TIMOTHY MCCULLOUGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1000 E CHERRY ST, TROY, MO 63379-1513
(636) 528-3221
Mailing address
PO BOX 790129, DEPT EC, SAINT LOUIS, MO 63179-0129
(800) 968-6866
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
R3L73
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
206007619
—
MO
Enumeration date
09/16/2005
Last updated
12/06/2007
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