Healthcare Provider Details

I. General information

NPI: 1881168367
Provider Name (Legal Business Name): JAMES FRANCIS PECULIS MPAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2019
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6812 STATE ROUTE 162 STE 200
MARYVILLE IL
62062-8562
US

IV. Provider business mailing address

12855 N 40 DR STE 375
SAINT LOUIS MO
63141-8657
US

V. Phone/Fax

Practice location:
  • Phone: 618-288-0900
  • Fax:
Mailing address:
  • Phone: 314-567-6071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085006934
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: