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:
Map and Directions

Health care specialties

SpecialtyCodeLicense #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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1356379184 NPPES
Illinois MEDICAID 036073000

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