Tillerson, Elbert Stinson
Tillerson, Elbert Stinson is an individual health care provider with primary practice located at 1125 Madison St. , Jefferson City MO 65102-1128. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Psychiatry, Allopathic & Osteopathic Physicians / Hospitalist. Allopathic & Osteopathic Physicians / Hospitalist is his primary health care specialty. Tillerson, Elbert Stinson can be contacted via phone (573) 635-7651.Contact Information
Primary practice address
1125 Madison St.
Jefferson City MO 65102-1128
Phone: (573) 635-7651
Fax: (573) 659-4515
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Psychiatry | 2084P0800X | 2011041481 | Missouri |
| Allopathic & Osteopathic Physicians / Hospitalist | 208M00000X | 2011041481 | Missouri |
Profile Details
| NPI number | 1003872714 |
|---|---|
| LBN Legal business name | Tillerson, Elbert Stinson |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Apr 21st, 2006 |
| Last updated | Jan 15th, 2013 - about 11 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1003872714 | NPPES |
| Georgia | Other | 054133 | LICENSE |
| Georgia | Other | 23919 | LICENSE |
| Georgia | MEDICAID | 1003872714 | LICENSE |
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