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Organization
PETER A TRACE, M.D.
Active
Organization
PETER A TRACE, M.D.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PETER ALEXANDER TRACE M.D. (OWNER)
(217) 243-8455
Entity
Organization
Contact information
Practice address
1600 W WALNUT ST, JACKSONVILLE, IL 62650-1136
(217) 243-8455
Mailing address
1600 W WALNUT ST, JACKSONVILLE, IL 62650-1136
(217) 243-8455
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
NULL
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010986
HEALTH ALLIANCE
IL
05
—
036048526
—
IL
01
—
06900105
BLUE CROSS BLUE SHIELD
IL
01
—
127838
HEALTHLINK
MO
01
—
13127
GROUP HEALTH PLAN
KY
Enumeration date
06/20/2007
Last updated
06/01/2009
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