Individual
JAMES R DEBORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1001 MAIN STREET, 3RD FLOOR, PEORIA, IL 61606-2037
(309) 495-0200
(309) 676-6545
Mailing address
1001 MAIN STREET, 3RD FLOOR, PEORIA, IL 61606-2037
(309) 495-0200
(309) 676-6545
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
036052063
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036052063-1
—
IL
01
—
7215166
BCBS
IL
Enumeration date
06/23/2006
Last updated
10/25/2012
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