Individual
CHRISTOPHER WILSON MODERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1 DOCTORS PARK RD STE C, MOUNT VERNON, IL 62864-6251
(618) 244-1234
Mailing address
PO BOX 802, MOUNT VERNON, IL 62864-0017
(618) 244-1234
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036079242
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036079242
—
IL
Enumeration date
02/14/2006
Last updated
11/04/2020
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