Organization
EDWARD W PEGG MD, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EDWARD W PEGG III MD (OWNER)
(309) 661-7344
Entity
Organization
Contact information
Practice address
1505 EASTLAND DR STE 2400, BLOOMINGTON, IL 61701-7911
(309) 661-7344
(309) 661-7343
Mailing address
1505 EASTLAND DR STE 2400, BLOOMINGTON, IL 61701-7911
(309) 661-7344
(309) 661-7343
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
036071077
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05732102
BCBS
IL
01
—
1043392160
INDIVIDUAL NPI
IL
Enumeration date
06/18/2007
Last updated
05/29/2008
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