Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 125.067202 | IL |
NPI | 1003298001 |
---|---|
Provider Name | Dr. Breck Jones |
First Address | Springfield, IL 62794-9680 |
Second Address | Springfield, IL 62702-5317 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2015 |
Last Update Date | 25/06/2015 |