Provider Demographics
NPI:1053478255
Name:STEPHEN J SOMMER MD A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:STEPHEN J SOMMER MD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:SOMMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-654-2494
Mailing Address - Street 1:4333 PIEDMONT AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-4715
Mailing Address - Country:US
Mailing Address - Phone:510-654-2494
Mailing Address - Fax:510-654-2464
Practice Address - Street 1:4333 PIEDMONT AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-4715
Practice Address - Country:US
Practice Address - Phone:510-654-2494
Practice Address - Fax:510-654-2464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC31412207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ29333ZMedicare ID - Type UnspecifiedGROUP MEDICARE NUMBER
CAA34560Medicare UPIN
ZZZ29333ZMedicare PIN