Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 125.076869 | IL |
Y | 208600000X | Surgeon | 125.076869 | IL |
NPI | 1003430166 |
---|---|
Provider Name | Conlan Joseph Pierce |
First Address | Urbana, IL 61801-1763 |
Second Address | Urbana, IL 61801 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2020 |
Last Update Date | 04/06/2020 |