Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 036.126074 | IL |
NPI | 1154535615 |
---|---|
Provider Name | Jasmin L Mcginty |
First Address | Springfield, IL 62794-9650 |
Second Address | Springfield, IL 62701-1041 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2007 |
Last Update Date | 19/11/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036126074 | (05) | IL |