Individual
JERRY PRIDDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
619 E MASON ST STE 5, SPRINGFIELD, IL 62701-1080
(217) 545-8000
(217) 545-2552
Mailing address
PO BOX 19639, SPRINGFIELD, IL 62794-9639
(217) 545-8000
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085006117
IL
363AS0400X
Surgical Physician Assistant
085006117
IL
Other
Enumeration date
12/28/2016
Last updated
12/18/2024
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