Spaniol, Jack P
Spaniol, Jack P is an individual health care provider with primary practice located at 308 Saint Joseph Dr , Bloomington IL 61701-3506. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Spaniol, Jack P can be contacted via phone (309) 663-5050.Contact Information
Primary practice address
308 Saint Joseph Dr
Bloomington IL 61701-3506
Phone: (309) 663-5050
Fax: (309) 662-3401
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 036-07300 | Illinois |
Profile Details
| NPI number | 1356379184 |
|---|---|
| LBN Legal business name | Spaniol, Jack P |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 29th, 2006 |
| Last updated | Mar 31st, 2011 - about 13 years ago |
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 | 1356379184 | NPPES |
| Illinois | MEDICAID | 036073000 |
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