Individual provider · NPI-1

Gregory Deters, M.D.

Family Medicine · Mattoon, IL

NPI number1497861702
StatusActive
Last updated in NPPESSep 21, 2018

Details

NPI
1497861702
Entity type
Individual (NPI-1)
Name
Gregory Deters
Credential
M.D.
Sex
Male
Sole proprietor
No
Enumeration date
Aug 21, 2006
Last updated
Sep 21, 2018

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207Q00000X Family Medicine036-087539ILYes

Practice location

200 Richmond Ave E
Mattoon, IL 61938-4652

Phone 217-234-7000 · Fax 217-238-5484

Mailing address

1005 Health Center Dr Ste 201
Mattoon, IL 61938-4693

Phone 217-234-6055

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