Individual
TAGGART VENEGAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2500 W REYNOLDS ST, PONTIAC, IL 61764-9774
(815) 842-2828
Mailing address
2500 W REYNOLDS ST, PONTIAC, IL 61764-9774
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085.009657
IL
Other
Enumeration date
06/05/2023
Last updated
06/05/2023
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