Individual
JAY WILLIAM DIECKHOFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M. D.
Contact information
Practice address
1005 BROADWAY ST, QUINCY, IL 62301-2834
(217) 223-8400
(217) 223-9945
Mailing address
824 SPRING LAKE DR, QUINCY, IL 62305-6152
(217) 223-4702
(217) 223-6984
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
036-064968
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00115241
BLUE SHIELD
IL
05
—
036064968
—
IL
01
—
110123
BLUE SHIELD
IL
Enumeration date
03/07/2007
Last updated
11/27/2023
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