Healthcare Provider Details

I. General information

NPI: 1164700183
Provider Name (Legal Business Name): JESSICA L SECOR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2011
Last Update Date: 03/28/2025
Certification Date: 03/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 ELM ST NE
ALBUQUERQUE NM
87102-2512
US

IV. Provider business mailing address

7725 N KNOXVILLE AVE
PEORIA IL
61614-2079
US

V. Phone/Fax

Practice location:
  • Phone: 505-841-1000
  • Fax:
Mailing address:
  • Phone: 309-495-0240
  • Fax: 309-689-9035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number36140614
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: