Individual
BRUCE SYLVESTER SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
104 W 6TH ST, STE 206, STREATOR, IL 61364-2899
(815) 672-1610
(815) 672-1615
Mailing address
104 W 6TH ST, STE 206, STREATOR, IL 61364-2899
(815) 672-1610
(815) 672-1615
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
36093924
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
36093924
—
IL
Enumeration date
07/12/2006
Last updated
09/30/2009
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