Individual
LARRY P TILL JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
504 MEDICAL CENTER BLVD, CONROE, TX 77304-2808
(409) 539-1111
(409) 788-8044
Mailing address
PO BOX 200993, HOUSTON, TX 77216-0993
(281) 784-1111
(281) 784-1555
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
J0314
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
139280516
—
TX
05
—
139280518
—
TX
01
—
1679553820
TRICARE SOUTH
TX
01
—
8F9642
BCBSTX PROV NO
TX
Enumeration date
01/21/2006
Last updated
12/01/2010
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