Individual
GREGORY T MOSKOP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5111 N GLEN PARK PLACE RD, PEORIA, IL 61614-4675
(309) 683-5700
(309) 683-5752
Mailing address
5111 N GLEN PARK PLACE RD, PEORIA, IL 61614-4675
(309) 683-5700
(309) 683-5752
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036074680
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036074680
—
IL
01
—
080167492
RAIL ROAD MEDICARE PIN
IL
01
—
09015685
BLUE CROSS BLUE SHIELD
IL
01
—
809840
MEDICARE GROUP #
IL
Enumeration date
05/17/2006
Last updated
04/28/2008
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