Provider Demographics
NPI:1972693281
Name:SOWELL, RONALD KEVIN (DPM)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:KEVIN
Last Name:SOWELL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 864943
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75086-4943
Mailing Address - Country:US
Mailing Address - Phone:469-467-0562
Mailing Address - Fax:469-467-0562
Practice Address - Street 1:2437 WINTERSTONE DR
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75023-7818
Practice Address - Country:US
Practice Address - Phone:469-467-0562
Practice Address - Fax:469-467-0562
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-15
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1152213E00000X, 213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF000F45C2Medicaid
TX00F45CMedicare ID - Type Unspecified
TXF000F45C2Medicaid