Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 036.131119 | IL |
NPI | 1073655676 |
---|---|
Provider Name | Mr. James Murray Jeffries III |
First Address | Peoria, IL 61614-4676 |
Second Address | Peoria, IL 61614-4676 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2007 |
Last Update Date | 07/09/2012 |