Provider Demographics
NPI:1356080576
Name:SOWDERS, JORDON ANDREW
Entity Type:Individual
Prefix:
First Name:JORDON
Middle Name:ANDREW
Last Name:SOWDERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CARMI
Mailing Address - State:IL
Mailing Address - Zip Code:62821-2402
Mailing Address - Country:US
Mailing Address - Phone:618-382-8300
Mailing Address - Fax:
Practice Address - Street 1:1000 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CARMI
Practice Address - State:IL
Practice Address - Zip Code:62821-2402
Practice Address - Country:US
Practice Address - Phone:618-382-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-04
Last Update Date:2022-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program