Eddie Lynn Paulk, D.O.
Internal Medicine in Maryville, IL. Individual provider (NPI-1).
NPI number1003813601
StatusActive
Last updated in NPPESAug 28, 2024
Details
- NPI
- 1003813601
- Entity type
- Individual (NPI-1)
- Name
- Mr. Eddie Lynn Paulk
- Credential
- D.O.
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Jun 29, 2005
- Certification date
- Aug 28, 2024
- Last updated
- Aug 28, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207R00000X | Internal Medicine | R9H10 | MO | Yes |
| 208D00000X | General Practice | R9H10 | MO |
Practice location
6812 State Route 162 Ste 21Maryville, IL 62062-8565
Phone 618-288-5566 · Fax 618-288-4005
Mailing address
6810 State Route 162 Box 215Maryville, IL 62062-8501
Phone 618-391-6405 · Fax 618-288-4088
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