Healthcare Provider Details

I. General information

NPI: 1326062621
Provider Name (Legal Business Name): RHONDA JO SOWARDS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 10/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1807 1ST ST
COAL VALLEY IL
61240-9347
US

IV. Provider business mailing address

1807 1ST ST
COAL VALLEY IL
61240-9347
US

V. Phone/Fax

Practice location:
  • Phone: 309-256-8597
  • Fax:
Mailing address:
  • Phone: 309-256-8597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number36437
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: