Provider Demographics
NPI:1194729517
Name:PROBST, JAMES E JR (DO)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:E
Last Name:PROBST
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:2250 N ILLINOIS AVE
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901-5612
Mailing Address - Country:US
Mailing Address - Phone:618-833-1691
Mailing Address - Fax:855-968-6372
Practice Address - Street 1:8 DOCTORS PARK RD
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-6224
Practice Address - Country:US
Practice Address - Phone:618-244-5500
Practice Address - Fax:855-968-6372
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036104243207L00000X, 207PE0004X, 207P00000X
IL036104243I208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILT01776Medicare PIN
ILF400272409Medicare PIN