Justin Dean Moody D.O.

NPI 1639370489 - Emergency Medicine - 207P00000X

NPI Details
NPI 1639370489
Gender Male
Enumeration Date 05/30/2007
Last Updated 07/08/2007
Entity Type Individual
Active Over 9 years ago
Practice Location
530 NE GLEN OAK AVE
PEORIA IL, 61603-3133, US
Phone (309) 655-4060
Fax
Business Location
611 W HIGH ST
PEORIA IL, 61606-1926, US
Phone (309) 922-9107
Fax
Toxanomy
Taxonomy Code 207P00000X
License State Illinois
License Number AS3581875-246
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According to our database, Dr. Justin Dean Moody D.O. NPI is 1639370489, taxonomy code is 207P00000X and license number is AS3581875-246, license state is located at Illinois. Justin Dean Moody D.O. physically located at 530 Ne Glen Oak Ave, Peoria IL, 61603-3133. NPI Number Justin Dean Moody D.O. has the Individual type.

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1639370489 NPI number is provided on an as is basis without warranty of any kind. 1639370489 is maintained by the National Plan & Provider Enumeration System. The contents of Justin Dean Moody D.O. are for informational purposes only.