Individual
DR. CHARLES H TILLMAN JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
720 MEDICAL PARK DR, MEXICO, MO 65265-3726
(573) 581-3240
(573) 581-7493
Mailing address
201 E MONROE ST, MEXICO, MO 65265-2852
(573) 581-3240
(573) 581-7493
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
36412
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
202409801
—
MO
Enumeration date
09/21/2005
Last updated
07/28/2023
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