Individual
LAURA SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
815 MAIN ST STE A, PEORIA, IL 61602
(309) 672-4977
Mailing address
815 MAIN ST STE A, PEORIA, IL 61602-1080
(309) 672-4977
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036131208
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036131208001
—
IL
Enumeration date
06/17/2009
Last updated
10/04/2018
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