Individual
JAY L MATHUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
530 NE GLEN OAK AVE, PEORIA, IL 61637
(309) 624-8818
Mailing address
530 NE GLEN OAK AVE, PEORIA, IL 61637-0001
(309) 624-8818
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036147093
IL
208M00000X
Hospitalist Physician
036147093
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/21/2015
Last updated
11/15/2024
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