Organization
PBM UROLOGY LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EUGENE DIXON M.D. (PRESIDENT)
(217) 528-7306
Entity
Organization
Contact information
Practice address
1215 S 4TH ST, SPRINGFIELD, IL 62703-2259
(217) 528-7306
Mailing address
1215 S 4TH ST, SPRINGFIELD, IL 62703-2259
(217) 528-7306
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
993660
MEDICARE ID
IL
Enumeration date
11/10/2006
Last updated
10/22/2007
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