MEDICARE: STEPHEN J SOMMER MD A PROFESSIONAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	C31412	CA

General Provider Information

NPI Number	:	1053478255
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEPHEN J SOMMER MD A PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	4333 PIEDMONT AVE
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94611-4715
Country	:	US
Telephone Number	:	510-654-2494
Fax Number	:	510-654-2464

Provider Business Practice Location Address
First Line	:	4333 PIEDMONT AVE
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94611-4715
Country	:	US
Telephone Number	:	510-654-2494
Fax Number	:	510-654-2464

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. STEPHEN JOHN SOMMER
Credential	:	M.D.
Telephone Number	:	510-654-2494

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	01/26/2009

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