Organization
EBO MD OF POPLAR BLUFF LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PHILIP JAMES CROCKER (CFO)
(573) 686-5510
Entity
Organization
Contact information
Practice address
2725 N WESTWOOD BLVD, POPLAR BLUFF, MO 63901-2346
(573) 686-5510
Mailing address
2725 N WESTWOOD BLVD STE 14, POPLAR BLUFF, MO 63901-2367
(573) 686-5510
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
06/22/2021
Last updated
07/26/2021
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