Regency Park Medical Group Llc

Specialty details in registry · O Fallon, IL

Call (480) 926-7800 Directions

At a glance

124 Regency Park Ste 7, O Fallon, IL 62269-1994

NPPES record updated Aug 19, 2021. Public records can lag behind changes at a practice.

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Practice location

124 Regency Park Ste 7
O Fallon, IL 62269-1994
Professional details: NPI, taxonomy & registry record
NPI1063034783
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Registry details

Primary taxonomy
Specialty details in registry
Taxonomy code
208D00000X
Enumeration date
May 15, 2020
Record updated
Aug 19, 2021
More registry details
Provider type
Organization · Type 2

Reported taxonomies and licenses

Chiropractor

111N00000X

Internal Medicine

207R00000X

Specialty details in registry

208D00000X · Primary

Physical Therapist

225100000X

Physician Assistant

363A00000X

Family Nurse Practitioner

363LF0000X

License numbers and credentials are reported to NPPES; HCPList does not independently verify them.

Practice location

124 Regency Park Ste 7
O Fallon, IL 62269-1994
Phone
(480) 926-7800
Mailing address
2250 E GERMANN RD STE 8

CHANDLER, AZ 852861575
Source: NPPES Source through Oct 18, 2026An NPI does not verify licensure or credentials.

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