Provider Demographics
NPI:1639163850
Name:TOMLIN, JEFFREY SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:SCOTT
Last Name:TOMLIN
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 1:3633 MUNICIPAL DR.
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050
Mailing Address - Country:US
Mailing Address - Phone:779-244-3072
Mailing Address - Fax:815-331-8389
Practice Address - Street 1:3633 MUNICIPAL DR
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-5434
Practice Address - Country:US
Practice Address - Phone:779-244-3072
Practice Address - Fax:815-331-8389
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036092485207R00000X
IL036.092485207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036092485OtherSTATE LICENSE
IL036092485OtherSTATE LICENSE
ILF95267Medicare UPIN