Doctor Name: | DR. EDDIE L. PAULK |
NPI Number: | 1003813601 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | D.O. |
License Number: | R9H10 |
Business Practice Address: | 960 E. Walnut Lawn Suite 201 Springfield, MO - 65807 |
Business Phone Number: | 4172694450 |
Business Fax Number: | 4172698333 |
Mailing Address: | 960 E. Walnut Lawn, Suite 201 SPRINGFIELD |
State: | MO |
Postal Code: | 65807 |
Phone Number: | 4172694450 |
Fax Number: | 4172698333 |
NPI Enumeration Date: | 06/29/2005 |
NPI Last Update Date: | 01/11/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | R9H10 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | MO |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |