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General NPI Number Information
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NPI Number | 1962504886
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Entity Type | Individual
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Provider Name | ROBERT LEE TILLEY MD
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Gender | Male
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Dates
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Enumeration Date | 09/01/2006
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Last Update Date | 04/03/2013
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Provider Practice Location Address
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Address Line | 1390 US HIGHWAY 61 SUITE 2300
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City | FESTUS
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State | MO
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Zip | 63028-4137
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Country | US
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Telephone | 636-937-3121
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Fax | 636-937-4423
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Provider Business Mailing Address
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Address Line | 1390 US HIGHWAY 61 SUITE 2300
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City | FESTUS
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State | MO
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Zip | 63028-4137
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Country | US
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Telephone | 636-937-3121
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Fax | 636-937-4423
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 2013004555
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License Number State | MO
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