NPI 1003351115

Jerry Priddy, PAC

Practitioner Physician Assistant Springfield, IL

Practice location

Address: 619 E Mason St STE 5, Springfield, IL 62701-1080
Phone: (217) 545-8000
Fax: (217) 545-2552
Mailing address: PO Box 19639, Springfield, IL 62794-9639

Registered specialties (2)

Physician Assistant Primary

Physician Assistants & Advanced Practice Nursing Providers Taxonomy 363A00000X Licence 085006117 (IL)

Other Physician Assistant providers in Illinois →

Surgical Physician Assistant

Physician Assistants & Advanced Practice Nursing Providers Taxonomy 363AS0400X Licence 085006117 (IL)

Registry record

NPI: 1003351115
Entity type: Individual
Sex (as registered): Male
NPI issued: 28 Dec 2016
Record last updated: 18 Dec 2024

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.