Provider Demographics
NPI:1871578062
Name:SOWARDS, MARTIN WAYNE (DO)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:WAYNE
Last Name:SOWARDS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:77 ADCOCK DR
Mailing Address - Street 2:
Mailing Address - City:ALAMOSA
Mailing Address - State:CO
Mailing Address - Zip Code:81101-8903
Mailing Address - Country:US
Mailing Address - Phone:719-589-2370
Mailing Address - Fax:719-587-0095
Practice Address - Street 1:77 ADCOCK DR
Practice Address - Street 2:
Practice Address - City:ALAMOSA
Practice Address - State:CO
Practice Address - Zip Code:81101-8903
Practice Address - Country:US
Practice Address - Phone:719-589-2370
Practice Address - Fax:719-587-0095
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-09
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO36261207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO20828527Medicaid
H02734Medicare UPIN