Individual
DR. JEFFREY SCOTT POULTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1505 EASTLAND DR, STE 350, BLOOMINGTON, IL 61701-3534
(309) 663-1222
(309) 663-0580
Mailing address
1505 EASTLAND DR, STE 350, BLOOMINGTON, IL 61701-3534
(309) 663-1222
(309) 663-0580
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
—
IL
2086S0122X
Plastic and Reconstructive Surgery Physician
MDR5N96
MO
2086S0122X
Plastic and Reconstructive Surgery Physician
—
IL
Other
Enumeration date
07/13/2005
Last updated
12/19/2007
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