John R Soderstrom in Peoria - Physician Assistant
John R Soderstrom - NPI 1871506931
John R Soderstrom is a Physician Assistant in Peoria, Illinois. John R Soderstrom practices all healthcare services and medical treatments related to Physician Assistant. The NPI Number for John R Soderstrom is 1871506931. The last update date is 2007-07-08.
John R Soderstrom's current location address is 4909 N Glen Park Place Rd, Peoria, Illinois. You can contact this provider via phone number 3096747546. The mailing address for John R Soderstrom is 4909 N Glen Park Place Rd, Peoria, Illinois. To know further, please read the information below!
Provider Profile Detail
Provider Name | John R Soderstrom |
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Address | 4909 N Glen Park Place Rd, Peoria, Illinois |
Phone Number | 3096747546 |
Fax Number | |
Sole Proprietor | N |
Credentials | P.A. |
NPI Number Detail
NPI Number | 1871506931 |
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Provider Enumeration Date | 2006-08-13 |
Last Updated Date | 2007-07-08 |
Provider Mailing Address Detail
Address | 4909 N Glen Park Place Rd |
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City | Peoria |
State | Illinois (IL) |
Post Code | 616144676 |
Phone Number | 3096747546 |
Fax Number |
Provider's Primary Taxonomy Detail
Speciality | Physician Assistant |
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Taxonomy | 363A00000X |
Definition: A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perfor |
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What is the unique identifier code issued to John R Soderstrom by the Centers for Medicare & Medicaid Services?
The John R Soderstrom has been assigned the NPI (National Provider Identifier) 1871506931. This 10-digit code serves as a unique identification number for healthcare providers issued by the Centers for Medicare & Medicaid Services (CMS).
Could you please provide the complete physical location address of John R Soderstrom?
The John R Soderstrom is physically situated at 4909 N Glen Park Place Rd, in the city of Peoria, state of IL, with the postal code 616144676.
What is John R Soderstrom's primary area of medical expertise, and what taxonomy classification code corresponds to this specialized field?
The primary area of medical expertise for John R Soderstrom is Physician Assistant, and the corresponding taxonomy classification code for this specialized field is 363A00000X.
On what date did the John R Soderstrom receive its 1871506931 assignment from the Centers for Medicare & Medicaid Services?
The John R Soderstrom was assigned its 1871506931 by the Centers for Medicare & Medicaid Services on 2006-08-13.
When was the information related to John R Soderstrom most recently updated or refreshed?
The details pertaining to the John R Soderstrom, including its address, specialty, and other relevant information, were last updated or refreshed on 2007-07-08.