Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Jack Edward Mordeson, MD

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1164217394

Jack Edward Mordeson, MD is a Student in an Organized Health Care Education/Training Program in Peoria, Illinois. Registered with an NPI since 2025.

In the registry since
2025
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

530 NE Glen Oak Ave
Peoria, IL 61637-2576
Phone: (309) 655-2000
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Student in an Organized Health Care Education/Training Program (primary) Taxonomy 390200000X

Record details

NPI number1164217394
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedApril 9, 2025
Last updated in NPPESApril 18, 2025
Certification dateApril 18, 2025
Mailing address530 Ne Glen Oak Ave, Peoria, IL 61637-0001

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