Provider Demographics
NPI:1669659389
Name:JAN O SONANDER, MD
Entity Type:Organization
Organization Name:JAN O SONANDER, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAN
Authorized Official - Middle Name:O
Authorized Official - Last Name:SONANDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-542-8700
Mailing Address - Street 1:11 DOCTORS PARK DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405
Mailing Address - Country:US
Mailing Address - Phone:707-542-8700
Mailing Address - Fax:707-528-8700
Practice Address - Street 1:11 DOCTORS PARK DR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405
Practice Address - Country:US
Practice Address - Phone:707-542-8700
Practice Address - Fax:707-528-8700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-24
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG56178207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G561780OtherMEDICARE GROUP PTAN
CA020A56290Medicare PIN
CAA16088Medicare UPIN
CA00G561780OtherMEDICARE GROUP PTAN
CAA53094Medicare UPIN
CA5281540001Medicare NSC