Organization
PAUL W. ILES INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PAUL W ILES JR. PSY. D. (PSYCHOLOGIST)
(417) 881-1580
Entity
Organization
Contact information
Practice address
2200 E SUNSHINE ST, SUITE 312, SPRINGFIELD, MO 65804-1819
(417) 881-1580
(417) 881-7004
Mailing address
2200 E SUNSHINE ST, SUITE 312, SPRINGFIELD, MO 65804-1819
(417) 881-1580
(417) 881-7004
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
1999140683
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
122501848
MEDICARE
MO
05
—
122501848
—
MO
Enumeration date
05/03/2010
Last updated
05/03/2010
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