Provider Demographics
NPI:1609843630
Name:SOMERS, PHILIP R JR (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:R
Last Name:SOMERS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3801 VISTA RD
Mailing Address - Street 2:#300
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77504-2159
Mailing Address - Country:US
Mailing Address - Phone:713-947-8544
Mailing Address - Fax:713-947-8601
Practice Address - Street 1:3801 VISTA RD
Practice Address - Street 2:#300
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-2159
Practice Address - Country:US
Practice Address - Phone:713-947-8544
Practice Address - Fax:713-947-8601
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD3404208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD3404OtherMEDICAL LICENSE
P425Medicare ID - Type Unspecified
TXB26564Medicare UPIN