Basic Information
| Provider Information | |||||||||
| NPI: | 1245237304 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FURRY | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 25288 | ||||||||
| Address2: | |||||||||
| City: | DECATUR | ||||||||
| State: | IL | ||||||||
| PostalCode: | 625255288 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8004446110 | ||||||||
| FaxNumber: | 8666421525 | ||||||||
| Practice Location | |||||||||
| Address1: | 1800 E LAKE SHORE DR | ||||||||
| Address2: | |||||||||
| City: | DECATUR | ||||||||
| State: | IL | ||||||||
| PostalCode: | 625213810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2174642729 | ||||||||
| FaxNumber: | 2174641693 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2005 | ||||||||
| LastUpdateDate: | 11/21/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 01035280A | IN | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 036-098884 | IL | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207LP2900X | 036098884 | IL | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 207LP2900X | 01035280A | IN | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 208600000X | 01035280A | IN | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 036-098884 | IL | N | Allopathic & Osteopathic Physicians | Surgery | 207LP2900X | 036-098884 | IL | Y | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 036098884 | 05 | IL | MEDICAID | 036098884 | 01 | IL | BCBS | OTHER |