Individual
RICHARD S SEABOCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
5405 N KNOXVILLE AVE, PEORIA, IL 61614
(309) 691-4410
(309) 589-2830
Mailing address
5405 N KNOXVILLE AVE, PEORIA, IL 61614
(309) 691-4410
(309) 589-2830
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085001201
IL
363AS0400X
Surgical Physician Assistant
085001201
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
085001201
—
IL
Enumeration date
08/02/2006
Last updated
08/31/2010
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