Provider Demographics
NPI:1679815377
Name:INKERRA MEDICAL PC
Entity Type:Organization
Organization Name:INKERRA MEDICAL PC
Other - Org Name:INKERRA FACIAL PLASTICS & RHINOLOGY PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IFEPO
Authorized Official - Middle Name:
Authorized Official - Last Name:SOFOLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-517-0008
Mailing Address - Street 1:63 N BACOPA DR
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77389-4980
Mailing Address - Country:US
Mailing Address - Phone:281-517-0008
Mailing Address - Fax:832-415-9542
Practice Address - Street 1:13215 DOTSON RD
Practice Address - Street 2:SUITE 140
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-4535
Practice Address - Country:US
Practice Address - Phone:281-517-0008
Practice Address - Fax:832-415-9542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-20
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN0472208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB105807Medicare PIN
TXI19200Medicare UPIN