Individual
DR. BONNIE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1701 W GARDEN ST, PEORIA, IL 61605-3531
(309) 680-7600
(309) 680-7686
Mailing address
2214 N UNIVERSITY ST, PEORIA, IL 61604-3221
(309) 495-8644
(309) 681-8443
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036091686
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036091686
—
IL
Enumeration date
07/19/2006
Last updated
09/15/2023
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