Provider Demographics
NPI:1114922929
Name:SOPER, DAVID H (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:H
Last Name:SOPER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2015 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46016-4337
Mailing Address - Country:US
Mailing Address - Phone:765-646-8243
Mailing Address - Fax:765-646-8655
Practice Address - Street 1:2015 JACKSON ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46016
Practice Address - Country:US
Practice Address - Phone:765-646-8243
Practice Address - Fax:765-646-8655
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01036847A146D00000X, 207ZM0300X, 207ZP0102X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
No207ZM0300XAllopathic & Osteopathic PhysiciansPathologyMedical Microbiology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN2099554OtherOHIO MEDICAID
IN020434700OtherBLACK LUNG PATHOLOGY GRP
IN930126124OtherMEDICARE RR
IN000000083417OtherANTHEM PATHOLOGY GROUP
IN6470OtherPHY HEALTH PLAN PATH GROU
IN000000013230OtherMPLAN PATHOLOGY GROUP
IN100332950Medicaid
IN930126124OtherMEDICARE RR
IN2099554OtherOHIO MEDICAID
INE06488Medicare UPIN
IN203790KMedicare PIN