Provider Demographics
NPI:1548437973
Name:SOBERA DERMATOLOGY GROUP, PC
Entity type:Organization
Organization Name:SOBERA DERMATOLOGY GROUP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:SOBERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-877-9773
Mailing Address - Street 1:2900 CAHABA RD
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN BRK
Mailing Address - State:AL
Mailing Address - Zip Code:35223-1937
Mailing Address - Country:US
Mailing Address - Phone:205-877-9773
Mailing Address - Fax:
Practice Address - Street 1:2900 CAHABA RD
Practice Address - Street 2:
Practice Address - City:MOUNTAIN BRK
Practice Address - State:AL
Practice Address - Zip Code:35223-1937
Practice Address - Country:US
Practice Address - Phone:205-877-9773
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL24170207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty