Individual
MARCI I MOORE-CONNELLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
405 W JACKSON ST, CARBONDALE, IL 62901-1462
(618) 457-5200
(618) 351-4820
Mailing address
405 W JACKSON ST, CARBONDALE, IL 62901-1462
(618) 457-5200
(618) 351-4820
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036-104541
IL
208M00000X
Hospitalist Physician
036104541
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036104541
—
IL
Enumeration date
12/21/2005
Last updated
12/08/2020
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