Dr. Jeffrey Scott Poulter
Surgeon Plastic and Reconstructive Surgery
1505 Eastland Dr Ste 350
Bloomington
, Illinois 61701-3534
Dr. Jeffrey Scott Poulter
Surgeon Plastic and Reconstructive Surgery
1505 Eastland Dr Ste 350
Bloomington
, Illinois 61701-3534
(309) 663-0580
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About
Features
Specialties
- Surgeon
- Plastic and Reconstructive Surgery
Languages spoken
- English
Location
First Address
- Dr. Jeffrey Scott Poulter
- 1505 Eastland Dr Ste 350
- Bloomington, IL
- Zip : 61701-3534
- Fax : (309) 663-0580
- Phone : (309) 663-1222
Second Address
- Dr. Jeffrey Scott Poulter
- 1505 Eastland Dr Ste 350
- Bloomington, IL
- Zip : 61701-3534
- Fax : (309) 663-0580
- Phone : (309) 663-1222
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 208200000X | Surgeon | IL | |
| Y | 208600000X | Surgeon | IL | |
| N | 2086S0122X | Plastic and Reconstructive Surgery | IL | |
| N | 2086S0122X | Plastic and Reconstructive Surgery | MDR5N96 | MO |
National Provider Identifier
| NPI | 1174521074 |
|---|---|
| Provider Name | Dr. Jeffrey Scott Poulter |
| First Address | Bloomington, IL 61701-3534 |
| Second Address | Bloomington, IL 61701-3534 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 13/07/2005 |
| Last Update Date | 19/12/2007 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| F27055 | (02) | |
| F27055 | (02) | IL |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.