Provider Demographics
NPI:1275735995
Name:SOMNER, JOHN PHILIP JR (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:PHILIP
Last Name:SOMNER
Suffix:JR
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 1:102 COULEE SHORE DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-3021
Mailing Address - Country:US
Mailing Address - Phone:337-789-0558
Mailing Address - Fax:337-326-5915
Practice Address - Street 1:102 COULEE SHORE DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-3021
Practice Address - Country:US
Practice Address - Phone:337-789-0558
Practice Address - Fax:337-326-5915
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK25260207Q00000X
LAMD.204120207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine