Individual
JOHN L. MALCOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
15 FOUNDERS LANE, JACKSONVILLE, IL 62650-3918
(217) 528-7541
(217) 243-9030
Mailing address
1025 S 6TH ST, SPRINGFIELD, IL 62703-2403
(217) 528-7541
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036-102583
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036102583
—
IL
Enumeration date
09/21/2006
Last updated
05/21/2020
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