Individual
DR. MARY JO IRONSIDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1221 E STATE ST, ROCKFORD, IL 61104-2231
(815) 972-1000
(815) 972-1086
Mailing address
1601 PARKVIEW AVE, CREDENTIALING S200C, ROCKFORD, IL 61107-1822
(815) 395-5861
(815) 395-5575
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036069571
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036069571
—
IL
Enumeration date
06/22/2006
Last updated
11/01/2023
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