Individual
JAMIE LYNN FREY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5401 N KNOXVILLE AVE, SUITE 115, PEORIA, IL 61614-5098
(309) 691-2903
(309) 691-2909
Mailing address
5401 N KNOXVILLE AVE, SUITE 115, PEORIA, IL 61614-5098
(309) 691-2903
(309) 691-2909
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
036124992
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036124992
—
IL
Enumeration date
05/03/2007
Last updated
07/15/2010
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