Provider Demographics
NPI:1730324468
Name:ROBERT E. SOPER, M.D.
Entity type:Organization
Organization Name:ROBERT E. SOPER, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:SOPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-445-4705
Mailing Address - Street 1:517 3RD ST STE 5
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-0460
Mailing Address - Country:US
Mailing Address - Phone:707-445-4705
Mailing Address - Fax:707-445-0581
Practice Address - Street 1:517 3RD ST STE 5
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-0460
Practice Address - Country:US
Practice Address - Phone:707-445-4705
Practice Address - Fax:707-445-0581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-09
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG59380174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB13905Medicare UPIN
CA00G593800Medicare PIN