Individual
FORDYCE EDWARD STIVERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
175 S MAIN ST, CANTON, IL 61520-2670
(309) 647-0201
(309) 649-5302
Mailing address
175 S MAIN ST, CANTON, IL 61520-2670
(309) 647-0201
(309) 649-5302
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
2005013768
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1780692087
CLINIC NPI#
IL
Enumeration date
02/27/2006
Last updated
03/27/2008
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