Provider Demographics
NPI:1437144532
Name:SOWADA, DAVID FELIX (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:FELIX
Last Name:SOWADA
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 1:413 AGATE ST
Mailing Address - Street 2:
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82901-6704
Mailing Address - Country:US
Mailing Address - Phone:307-382-0614
Mailing Address - Fax:307-382-0614
Practice Address - Street 1:413 AGATE ST
Practice Address - Street 2:
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-6704
Practice Address - Country:US
Practice Address - Phone:307-382-0614
Practice Address - Fax:307-382-0614
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY2529A207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY304685OtherBLUE CROSS & BLUE SHIELD
WYE19626Medicare UPIN
WYW304685Medicare ID - Type Unspecified