person
Erica M Deford, PA
Medical Physician Assistant in Peoria, Illinois
NPI 1306020334

Erica M Deford is a Medical Physician Assistant based in Peoria, IL and is specialized in Medical. Erica M Deford practices in Peoria, IL and has the professional credentials of PA. The NPI Number for Erica M Deford is 1306020334 and holds a License No. 085003126 (Illinois).

The current practice location address for Erica M Deford is 2805 N Knoxville Ave, Peoria, IL and can be reached out via phone at 309-624-9400 and via fax at 309-624-2280.

Location: 2805 N Knoxville Ave, Peoria, IL, 61604-2869
person
Provider Profile Details
NPI Number
1306020334
Provider Name
Erica M Deford
Credential
PA
Provider Entity Type
Individual
Gender
Female
Address
2805 N Knoxville Ave, Peoria, IL, 61604-2869
Phone Number
309-624-9400
Fax Number
309-624-2280
Provider Enumeration Date
12/27/2007
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
809840 01 IL MEDICARE GROUP PTAN
776530 01 IL MEDICARE GROUP PIN
37-1221637 01 TAX ID
institution
Provider Business Practice Location Address Details
Address
2805 N Knoxville Ave
City
State
Zip
61604-2869
Phone Number
309-624-9400
Fax Number
309-624-2280
person
Provider Business Mailing Address Details
Address
2805 N Knoxville Ave
City
State
Zip
61604-2869
Phone Number
309-624-9400
Fax Number
309-624-2280
person
Provider's Taxonomy Details 1
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Physician Assistant
Speciality
Medical
Taxonomy
License No.
085003126 (Illinois)
Definition
Definition to come...
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