Individual
DR. JAMES FAIRD TACKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
221 NE GLEN OAK AVE, PEORIA, IL 61636-0001
(309) 999-1091
Mailing address
RR 1 BOX 46-25, RED HOUSE, WV 25168-9713
(304) 586-0915
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
036-117166
IL
207P00000X
Emergency Medicine Physician
7956
WV
207P00000X
Emergency Medicine Physician
Primary
ME107562
FL
207R00000X
Internal Medicine Physician
MD.30275
AL
207R00000X
Internal Medicine Physician
TL7008
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036117166
—
IL
01
—
36117166
BCBS
IL
01
—
P00376164
RAILROAD MCARE
IL
Enumeration date
08/13/2006
Last updated
04/07/2025
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