Organization Name: | OB PRACTICE, LLC |
NPI Number: | 1770946204 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JAMES B DAVIS (EXECUTIVE DIRECTOR) |
Mailing Address: | 1404 Cross St Third Floor Suite 3181 Shiloh |
State: | IL US |
Postal Code: | 622692988 |
Phone Number: | 6182574644 |
Fax Number: | |
NPI Enumeration Date: | 04/01/2016 |
NPI Last Update Date: | 04/28/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 207VG0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Obstetrics & Gynecology |
Taxonomy Specialization: | Gynecology |
Taxonomy Definition: |