Individual
ELIZABETH A SMALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1025 S 6TH ST, SPRINGFIELD, IL 62703-2403
(217) 528-7541
Mailing address
1025 S 6TH ST, SPRINGFIELD, IL 62703-2403
(217) 528-7541
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
036057816
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036057816
—
IL
Enumeration date
10/26/2006
Last updated
07/20/2011
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