Individual
DR. THEODORE MARTIN WILLMORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
100 SAINT MARYS PLZ, JEFFERSON CITY, MO 65101-1602
(573) 761-7011
Mailing address
4102 BIG SUR BLVD, COLUMBIA, MO 65203-6704
(573) 447-1851
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
2000153519
MO
Other
Enumeration date
08/22/2006
Last updated
12/07/2012
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