NPI 1740560580

State of Missouri

Organisation Family Medicine Physician Poplar Bluff, MO

Practice location

Address: 2351 Kanell Blvd, Poplar Bluff, MO 63901-4035
Phone: (573) 840-9370
Fax: (573) 840-9373
Mailing address: PO Box 687, Jefferson City, MO 65102-0687

Authorised official

Name: Molly Jane Boeckmann
Title: Director of Administrative Services
Phone: (573) 751-4055

Registered specialties (2)

Family Medicine Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 207Q00000X

Other Family Medicine providers in Missouri →

Emergency Medicine Physician

Allopathic & Osteopathic Physicians Taxonomy 207P00000X

Other Emergency Medicine providers in Missouri →

Registry record

NPI: 1740560580
Entity type: Organization
NPI issued: 25 Aug 2011
Record last updated: 15 Oct 2020

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.