Provider Demographics
NPI:1760701007
Name:VERZAL, RHONDA R (MD)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:R
Last Name:VERZAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RHONDA
Other - Middle Name:R
Other - Last Name:DEPAUL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1601 PARKVIEW AVENUE
Mailing Address - Street 2:CREDENTIALING S200C
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-6846
Mailing Address - Country:US
Mailing Address - Phone:815-395-5861
Mailing Address - Fax:815-395-5575
Practice Address - Street 1:1221 E STATE ST
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61104-2231
Practice Address - Country:US
Practice Address - Phone:815-972-1000
Practice Address - Fax:815-972-1086
Is Sole Proprietor?:No
Enumeration Date:2010-05-26
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME111025207Q00000X
IL036-146484207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004587400Medicaid
FL14K04OtherFLORIDA BLUE
FLFX999ZMedicare PIN