Provider Demographics
NPI:1871580241
Name:ATILES, JOSE A (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:A
Last Name:ATILES
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Gender:M
Credentials:MD
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Mailing Address - Street 1:2300 HAMMOND MILL LN
Mailing Address - Street 2:
Mailing Address - City:WEST PLAINS
Mailing Address - State:MO
Mailing Address - Zip Code:65775-6548
Mailing Address - Country:US
Mailing Address - Phone:417-256-2511
Mailing Address - Fax:417-926-1785
Practice Address - Street 1:1905 W 19TH ST
Practice Address - Street 2:
Practice Address - City:MOUNTAIN GROVE
Practice Address - State:MO
Practice Address - Zip Code:65711-1287
Practice Address - Country:US
Practice Address - Phone:417-926-1770
Practice Address - Fax:417-926-1785
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2018-04-04
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Provider Licenses
StateLicense IDTaxonomies
MO112620207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO209187707Medicaid
MO26D2006074OtherCLIA
MO1871580241Medicaid