Individual
JACOB GRAHAM LANTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
739 N JEFFERSON ST, MASCOUTAH, IL 62258-1447
(618) 566-8810
Mailing address
739 N JEFFERSON ST, MASCOUTAH, IL 62258-1447
(618) 566-8810
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036161533
IL
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
04/04/2019
Last updated
08/17/2022
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