Provider Demographics
NPI:1023170057
Name:VERNIER, REGINALD L (MD)
Entity type:Individual
Prefix:DR
First Name:REGINALD
Middle Name:L
Last Name:VERNIER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 S SCOTT AVE
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:IL
Mailing Address - Zip Code:62448-1665
Mailing Address - Country:US
Mailing Address - Phone:618-783-8713
Mailing Address - Fax:618-783-4170
Practice Address - Street 1:500 S SCOTT AVE
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:IL
Practice Address - Zip Code:62448-1665
Practice Address - Country:US
Practice Address - Phone:618-783-8713
Practice Address - Fax:618-783-4170
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL371287000001Medicaid
IL371287000001Medicaid
IL143835Medicare Oscar/Certification