Provider Demographics
NPI:1962434100
Name:PROUDFOOT, SONIA E (MD)
Entity type:Individual
Prefix:MRS
First Name:SONIA
Middle Name:E
Last Name:PROUDFOOT
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 1:166 HOSPITAL STREET
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:KY
Mailing Address - Zip Code:42633-2416
Mailing Address - Country:US
Mailing Address - Phone:606-348-9343
Mailing Address - Fax:606-340-3258
Practice Address - Street 1:166 HOSPITAL STREET
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:KY
Practice Address - Zip Code:42633-2416
Practice Address - Country:US
Practice Address - Phone:606-348-9343
Practice Address - Fax:606-340-3258
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY35830207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000558830OtherANTHEM BC & BS
KY64050149Medicaid
KY0340Medicare PIN
KY3334429Medicare PIN
KYH64267Medicare UPIN