# PETER A TRACE, M.D.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1538364393
- **Authorized official:** MR. PETER ALEXANDER TRACE M.D. (OWNER)
- **Authorized official phone:** (217) 243-8455

## Contact information

- **Practice address:** 1600 W WALNUT ST, JACKSONVILLE, IL 62650-1136
- **Practice address phone:** (217) 243-8455
- **Mailing address:** 1600 W WALNUT ST, JACKSONVILLE, IL 62650-1136
- **Mailing address phone:** (217) 243-8455

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | Yes |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/20/2007
- **Last updated:** 06/01/2009

## 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 |