Provider Demographics
NPI:1902866163
Name:JOHARI, SOMA B (MD)
Entity Type:Individual
Prefix:DR
First Name:SOMA
Middle Name:B
Last Name:JOHARI
Suffix:
Gender:F
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 847408
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-7408
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:900 QUEST PKWY
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-2270
Practice Address - Country:US
Practice Address - Phone:512-260-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9575207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1487720-01OtherCSHCN
TX080172621OtherRR/MEDICARE
TX8B0454OtherBLUE SHIELD
TX1440869-01Medicaid
TX1440869-01Medicaid
TX8B0454OtherBLUE SHIELD