Provider Demographics
NPI:1295829836
Name:SOONG, VERA Y (MD)
Entity Type:Individual
Prefix:
First Name:VERA
Middle Name:Y
Last Name:SOONG
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 1:817 PRINCETON AVE SW
Mailing Address - Street 2:POB III; SUITE 302
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35211-1333
Mailing Address - Country:US
Mailing Address - Phone:205-781-6995
Mailing Address - Fax:205-781-8783
Practice Address - Street 1:817 PRINCETON AVENUE S.W.
Practice Address - Street 2:POB II; SUITE 302
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35211
Practice Address - Country:US
Practice Address - Phone:205-781-6995
Practice Address - Fax:205-781-8783
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL13000207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000092979Medicaid
AL000092979Medicaid
AL92979Medicare ID - Type Unspecified