Provider Demographics
NPI:1326062621
Name:SOWARDS, RHONDA JO (MD)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:JO
Last Name:SOWARDS
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 1:1807 1ST ST
Mailing Address - Street 2:
Mailing Address - City:COAL VALLEY
Mailing Address - State:IL
Mailing Address - Zip Code:61240-9347
Mailing Address - Country:US
Mailing Address - Phone:309-256-8597
Mailing Address - Fax:
Practice Address - Street 1:1807 1ST ST
Practice Address - Street 2:
Practice Address - City:COAL VALLEY
Practice Address - State:IL
Practice Address - Zip Code:61240-9347
Practice Address - Country:US
Practice Address - Phone:309-256-8597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA36437207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAP00616056OtherRR MEDICARE
IAP00411063OtherRAILROAD MEDICARE
IA01071OtherWELLMARK BCBS
IA36437OtherSTATE MEDICAL LICENSE
IAP00616056OtherRR MEDICARE
I69308Medicare UPIN
ILK38820Medicare PIN
IAI19967Medicare PIN
IAP00411063Medicare PIN