Pegg, Edward W
Pegg, Edward W is an sole proprietor health care provider with primary practice located at 2204 Eastland Dr , Bloomington IL 61704-3567. He recently has only one registered license in Allopathic & Osteopathic Physicians / Neurology, which is considered as his primary health care specialty. Pegg, Edward W can be contacted via phone (309) 661-6900.Contact Information
Primary practice address
2204 Eastland Dr
Bloomington IL 61704-3567
Phone: (309) 661-6900
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Neurology | 2084N0400X | 036071077 | Illinois |
Profile Details
| NPI number | 1043392160 |
|---|---|
| LBN Legal business name | Pegg, Edward W |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Oct 19th, 2006 |
| Last updated | Apr 26th, 2024 - about last year |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1043392160 | NPPES |
| Illinois | MEDICAID | 036071077 |
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