Provider Demographics
NPI:1811334485
Name:GOWDA, JAYASHREE T (MD)
Entity type:Individual
Prefix:
First Name:JAYASHREE
Middle Name:T
Last Name:GOWDA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 35TH AVE
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-6176
Mailing Address - Country:US
Mailing Address - Phone:309-788-0014
Mailing Address - Fax:309-623-4638
Practice Address - Street 1:612 35TH AVE
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-6176
Practice Address - Country:US
Practice Address - Phone:309-788-0014
Practice Address - Fax:309-623-4638
Is Sole Proprietor?:No
Enumeration Date:2013-05-23
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036148094207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism