Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 036102112 | IL |
NPI | 1003929175 |
---|---|
Provider Name | Dr. Toni Scott-Terry |
First Address | South Holland, IL 60473-2258 |
Second Address | Olympia Fields, IL 60461-1010 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2006 |
Last Update Date | 20/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036102112 | (05) | IL |
F400214350 | MEDICARE PTAN (01) | IL |
H56481 | (02) | IL |