John R Soderstrom, P.A.
John R Soderstrom is a Physician Assistant provider (Physician Assistant) practicing in Peoria, IL, registered in the NPPES registry with NPI 1871506931 since 2006. The credential PA stands for Physician Assistant.
✓ Active NPI ✓ Valid NPI checksum
| NPI | 1871506931 |
|---|---|
| Entity type | Individual (Type 1) |
| Name | John R Soderstrom |
| Credential | P.A. |
| Sex | Male |
| Practice address | 4909 N GLEN PARK PLACE RD, Peoria, IL, 61614 |
| Phone | 3096747546 |
| Enumeration date | 2006-08-13 |
| Last updated in NPPES | 2007-07-08 |
Taxonomy & licenses
| Taxonomy code | Specialty | Primary | License | State |
|---|---|---|---|---|
| 363A00000X | Physician Assistant | Primary | — | — |
PA — Physician Assistant: A licensed clinician who practices medicine in collaboration with physicians, trained in a graduate PA program. About the PA credential
Copy-ready billing details
Provider: John Soderstrom, P.A. NPI: 1871506931 Taxonomy: 363A00000X (Physician Assistant) Address: 4909 N GLEN PARK PLACE RD, Peoria, IL, 61614
Other providers at this practice address
| NPI | Name | Type | Specialty | Location |
|---|---|---|---|---|
| 1417923517 | John Lomax | Individual | Plastic Surgery Physician | Peoria, IL |
| 1053370759 | Carl Soderstrom | Individual | Dermatopathology Physician | Peoria, IL |
| 1093774705 | Stuart Berryman | Individual | Medical Physician Assistant | Peoria, IL |
| 1053362343 | Soderstrom Dermatology Center S C | Organization | Ambulatory Surgical Clinic/Center | Peoria, IL |
| 1710931670 | Soderstrom Dermatology Center S C | Organization | Dermatology Physician | Peoria, IL |
| 1912017245 | Michael Hayes | Individual | Dermatology Physician | Peoria, IL |
| 1518046044 | Todd Gerlach | Individual | Plastic Surgery Physician | Peoria, IL |
| 1073655676 | James Jeffries | Individual | Plastic and Reconstructive Surgery Physician | Peoria, IL |
Verify this record
Cross-check NPI 1871506931 against the authoritative CMS record: view John R Soderstrom on the official NPPES registry .
What is an NPI number?
A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes — even if the provider moves or changes specialty. Read the full guide or validate an NPI number.
Frequently asked questions
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Source: CMS NPPES (public data). Snapshot 2026-07-11. Provider record last updated 2007-07-08.