Healthcare Provider Details

I. General information

NPI: 1063460343
Provider Name (Legal Business Name): JENNY OAKES SOBERA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 04/04/2025
Certification Date: 04/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 CAHABA RD
MOUNTAIN BRK AL
35223-1937
US

IV. Provider business mailing address

801 YORK ST
MANITOWOC WI
54220-4630
US

V. Phone/Fax

Practice location:
  • Phone: 205-877-9773
  • Fax: 205-877-9775
Mailing address:
  • Phone: 920-663-9008
  • Fax: 920-684-1439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD.24170
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: