Provider Demographics
NPI:1710915525
Name:SOLER, AMBROSE (MD)
Entity Type:Individual
Prefix:DR
First Name:AMBROSE
Middle Name:
Last Name:SOLER
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 1:1338 PHAY AVE
Mailing Address - Street 2:BLDG D PEDS
Mailing Address - City:CANON CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81212-2326
Mailing Address - Country:US
Mailing Address - Phone:719-285-2091
Mailing Address - Fax:719-285-2092
Practice Address - Street 1:1338 PHAY AVE
Practice Address - Street 2:BLDG D PEDS
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212
Practice Address - Country:US
Practice Address - Phone:719-285-2091
Practice Address - Fax:719-285-2092
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME53270208000000X
WY8373A208000000X
CODR.0057467208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY1710915525OtherBCBS
WY1710915525Medicaid
FL025039900Medicaid