Healthcare Provider Details

I. General information

NPI: 1114958048
Provider Name (Legal Business Name): MAYRA A ARZON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE MEMORIAL DR STE 101
DECATUR IL
62526
US

IV. Provider business mailing address

ONE MEMORIAL DR STE 101
DECATUR IL
62526
US

V. Phone/Fax

Practice location:
  • Phone: 217-875-0690
  • Fax: 217-875-4148
Mailing address:
  • Phone: 217-875-0690
  • Fax: 217-875-4148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: