Organization
ORTHOPEDIC & SPORTS MEDICINE CLINIC, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRUCE T VEST M.D. (PRESIDENT)
(618) 474-8052
Entity
Organization
Contact information
Practice address
4411 ALBY ST, ALTON, IL 62002-5916
(618) 474-8052
(618) 474-8054
Mailing address
4411 ALBY ST, ALTON, IL 62002-5916
(618) 474-8052
(618) 474-8054
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
036074778
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036074778
—
IL
Enumeration date
07/08/2006
Last updated
03/11/2010
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