Healthcare Provider Details

I. General information

NPI: 1437106101
Provider Name (Legal Business Name): DAVID S ASBERY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 04/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 CUSUMANO PROFESSIONAL PLAZA DR
MOUNT VERNON IL
62864-6736
US

IV. Provider business mailing address

8 CUSUMANO PROFESSIONAL PLAZA DR
MOUNT VERNON IL
62864-6736
US

V. Phone/Fax

Practice location:
  • Phone: 618-244-4800
  • Fax:
Mailing address:
  • Phone: 618-244-4800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number052127
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036117749
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: