Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207L00000X | Anesthesiologist | 036104243 | IL |
Y | 207P00000X | Emergency Physician | 036104243 | IL |
N | 207PE0004X | Emergency Medical Services | 036104243 | IL |
N | 208D00000X | General Practice Physician | 036104243I | IL |
NPI | 1194729517 |
---|---|
Provider Name | Dr. James E. Probst JR. |
First Address | Carbondale, IL 62901-5612 |
Second Address | Mount Vernon, IL 62864-6224 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2005 |
Last Update Date | 17/02/2016 |