Provider Demographics
NPI:1174509210
Name:SOMERA, GERALDINE ANN JAVIER (MD)
Entity Type:Individual
Prefix:DR
First Name:GERALDINE
Middle Name:ANN JAVIER
Last Name:SOMERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-0000
Mailing Address - Country:US
Mailing Address - Phone:541-267-5151
Mailing Address - Fax:541-266-4577
Practice Address - Street 1:1900 WOODLAND DR
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-0000
Practice Address - Country:US
Practice Address - Phone:541-267-5151
Practice Address - Fax:541-266-4577
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-20
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD26363207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1407812365OtherNBMC GROUP NPI NUMBER
0-572-799-5OtherECFMG#
ORCB3544OtherRR MEDICARE GROUP PIN
OR027895Medicaid
ORR0000WFBTVOtherGROUP MEDICARE PIN NUMBER
ORP00302238OtherRR MEDICARE PTAN NUMBER
OR027895Medicaid
ORI44166Medicare UPIN
0-572-799-5OtherECFMG#
OR1407812365OtherNBMC GROUP NPI NUMBER