Icdoc LLC
NPI #1629756929 in Poplar Bluff, Missouri
Provider Information
- NPI Number
- 1629756929
- Entity Type
- Organization
- Organization Name
- Icdoc LLC
- Primary Specialty
- Clinic/Center - Primary Care
- Enumeration Date
- Jul 6, 2023
- Last Updated
- Jul 6, 2023
Practice Location
- Address
- 2445 N WESTWOOD BLVD STE 100
- City
- Poplar Bluff
- State
- Missouri
- ZIP Code
- 63901-2317
- Phone
- (573) 776-0157
Authorized Official
- Name
- SHELLY GRESHAM, RN, NP-C
- Title
- MEMBER, ADMINISTRATOR
- Phone
- (573) 776-0157
Specialties & Taxonomy Codes
| Specialty |
|---|
| Clinic/Center - Primary Care — Primary Care |
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