Individual
BILLY JOE MEDLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
20445 BANGOR RD, CROCKER, MO 65452-8239
(573) 528-4153
Mailing address
20445 BANGOR RD, CROCKER, MO 65452-8239
(573) 528-4153
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
171WH0202X
Home Modifications Contractor
—
—
Other
Enumeration date
10/23/2023
Last updated
10/23/2023
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