Organization
EBO MD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GENNI L OURTH (MANAGER)
(573) 803-2941
Entity
Organization
Contact information
Practice address
1417 N MOUNT AUBURN RD STE A, CAPE GIRARDEAU, MO 63701-2171
(573) 803-2941
(573) 803-0815
Mailing address
1417 N MOUNT AUBURN RD STE A, CAPE GIRARDEAU, MO 63701-2171
(573) 803-2941
(573) 803-0815
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
02/04/2019
Last updated
02/04/2019
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