Provider Demographics
NPI:1871838656
Name:SONODA, TAKUO (MD)
Entity Type:Individual
Prefix:
First Name:TAKUO
Middle Name:
Last Name:SONODA
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 1:729 SELF HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:TN
Mailing Address - Zip Code:37853-3413
Mailing Address - Country:US
Mailing Address - Phone:865-970-2078
Mailing Address - Fax:865-981-4652
Practice Address - Street 1:729 SELF HOLLOW RD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:TN
Practice Address - Zip Code:37853-3413
Practice Address - Country:US
Practice Address - Phone:865-970-2078
Practice Address - Fax:865-981-4652
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-04
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000008626207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine