Provider Demographics
NPI:1659353555
Name:SOMMERHAUG, EILER JOHN (MD)
Entity Type:Individual
Prefix:
First Name:EILER
Middle Name:JOHN
Last Name:SOMMERHAUG
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:PO BOX 751375
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:75137
Mailing Address - Country:US
Mailing Address - Phone:707-766-9852
Mailing Address - Fax:707-766-1749
Practice Address - Street 1:1383 N MCDOWELL BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-1187
Practice Address - Country:US
Practice Address - Phone:707-766-9852
Practice Address - Fax:707-766-1749
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-16
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG810432086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR002104ROtherMEDI-CAL
CAGR002104ROtherMEDI-CAL