Provider Demographics
NPI:1679572002
Name:SOMERS, HOWARD BRUCE (MD)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:BRUCE
Last Name:SOMERS
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 1:234 A AVE
Mailing Address - Street 2:
Mailing Address - City:CORONADO
Mailing Address - State:CA
Mailing Address - Zip Code:92118-1913
Mailing Address - Country:US
Mailing Address - Phone:619-435-5504
Mailing Address - Fax:619-435-5519
Practice Address - Street 1:234 A AVE
Practice Address - Street 2:
Practice Address - City:CORONADO
Practice Address - State:CA
Practice Address - Zip Code:92118-1913
Practice Address - Country:US
Practice Address - Phone:619-435-5504
Practice Address - Fax:619-435-5519
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMD11456174400000X
CAC51096174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1Z0323OtherHEALTHNET OF AZ
AZ4406462OtherAETNA
CAC51096OtherCA MEDICAL LICENSE
AZ19-00023OtherUNITED HEALTHCARE
AZAZ0349600OtherBCBS
AZMD11456OtherAZ MEDICAL LICENSE
AZ100957OtherONE HEALTHPLAN
AZ4219600OtherCIGNA
AZ4219600OtherCIGNA