Individual
GARY BRETT WESTERN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
800 N. 1ST STREET, SPRINGFIELD, IL 62702
(217) 528-7541
Mailing address
1025 S 6TH ST, SPRINGFIELD, IL 62703-2403
(217) 528-7541
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
036-106083
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036106083
—
IL
Enumeration date
08/31/2006
Last updated
05/19/2020
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