MEDICARE: DR. JOHN C. DAILEY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	36057937	IL

General Provider Information

NPI Number	:	1063487775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN C. DAILEY M.D.

Provider Business Mailing Address
First Line	:	1600 W WALNUT ST
Second Line	:
City	:	JACKSONVILLE
State	:	IL
Zip	:	62650-1136
Country	:	US
Telephone Number	:	217-243-9426
Fax Number	:	217-243-1647

Provider Business Practice Location Address
First Line	:	1600 W WALNUT ST
Second Line	:
City	:	JACKSONVILLE
State	:	IL
Zip	:	62650-1136
Country	:	US
Telephone Number	:	217-243-9426
Fax Number	:	217-243-1647

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/17/2006
Last Update Date	:	07/08/2007

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