MEDICARE: DAVID SOMMERHALDER

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	390200000X	Student in an Organized Health Care Education/Training Program
2	207R00000X	Internal Medicine Physician	S5270	TN
3	207RH0003X	Hematology & Oncology Physician	S5270	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821417270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID SOMMERHALDER

Provider Business Mailing Address
First Line	:	PO BOX 911230
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75391-1230
Country	:	US
Telephone Number	:	972-997-8000
Fax Number	:	972-234-2987

Provider Business Practice Location Address
First Line	:	2829 BABCOCK RD STE 300
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-6011
Country	:	US
Telephone Number	:	210-580-9500
Fax Number	:	210-568-4397

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

Provider Enumeration Date	:	04/14/2014
Last Update Date	:	12/13/2021

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Directions to “ DAVID SOMMERHALDER ” Practice Location

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