MEDICARE: KATHLEEN R SOCH MD

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	B26552	TX
2	207Q00000X	Family Medicine Physician	G0145	TX
3	207QG0300X	Geriatric Medicine (Family Medicine) Physician	B26552	TX
4	207QG0300X	Geriatric Medicine (Family Medicine) Physician	G0145	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	1L5842	OTHER	TX	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P02601817	OTHER	TX	MCRR
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134126717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN R SOCH MD

Provider Business Mailing Address
First Line	:	919 HIDDEN RDG
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75038-3813
Country	:	US
Telephone Number	:	469-282-2711
Fax Number	:	469-282-2609

Provider Business Practice Location Address
First Line	:	2606 HOSPITAL BLVD STE B
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78405-1804
Country	:	US
Telephone Number	:	361-902-4789
Fax Number	:	361-902-4588

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	04/08/2021

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Directions to “ KATHLEEN R SOCH MD” Practice Location

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