Edward W Pegg III
Neurologist
1505 Eastland Dr Suite 2400
Bloomington
, Illinois 61701-3534
Edward W Pegg III
Neurologist
1505 Eastland Dr Suite 2400
Bloomington
, Illinois 61701-3534
(309) 661-7343
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About
Features
Specialties
- Neurologist
Languages spoken
- English
Location
First Address
- Edward W Pegg III
- 1505 Eastland Dr Suite 2400
- Bloomington, IL
- Zip : 61701-3534
- Fax : (309) 661-7343
- Phone : (309) 661-7344
Second Address
- Edward W Pegg III
- 1505 Eastland Dr Suite 2400
- Bloomington, IL
- Zip : 61701-3534
- Fax : (309) 661-7343
- Phone : (309) 661-7344
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 2084N0400X | Neurologist | 036071077 | IL |
National Provider Identifier
| NPI | 1043392160 |
|---|---|
| Provider Name | Edward W Pegg III |
| 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 | 19/10/2006 |
| Last Update Date | 08/07/2007 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 036071077 | (05) | IL |
| K26678 | (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.