Individual
MR. JASON D CHURCHILL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1306 MAPLE ST, ELDORADO, IL 62930-1662
(618) 273-3361
(618) 273-2504
Mailing address
510 LINCOLN DR, HERRIN, IL 62948-6334
(618) 997-4310
(618) 998-9635
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
085-002808
IL
363AM0700X
Medical Physician Assistant
2006030653
MO
Other
Enumeration date
12/11/2006
Last updated
02/14/2019
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