Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 036-118863 | IL |
Y | 207VE0102X | Reproductive Endocrinologist | 036-118863 | IL |
NPI | 1326071887 |
---|---|
Provider Name | Julio R Loret De Mola |
First Address | Springfield, IL 62702-4968 |
Second Address | Springfield, IL 62702-4968 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2006 |
Last Update Date | 22/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036118863 | (05) | IL |
F79801 | (02) |