Individual
MR. CHARLES R TILLEY JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
180 10TH ST SE STE 201, LE MARS, IA 51031-2557
(712) 546-4624
(712) 546-9395
Mailing address
PO BOX 70, LE MARS, IA 51031-0070
(712) 546-4624
(712) 546-9395
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
001775
IA
363A00000X
Physician Assistant
1409
NE
Other
Enumeration date
01/12/2007
Last updated
10/19/2022
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