Healthcare Provider Details

I. General information

NPI: 1215960430
Provider Name (Legal Business Name): ANTHONY SOMKIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 12/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 MILVIA ST SUITE 228
BERKELEY CA
94704-2636
US

IV. Provider business mailing address

1310 COMMERCE ST SUITE B
PETALUMA CA
94954-1469
US

V. Phone/Fax

Practice location:
  • Phone: 510-548-8888
  • Fax: 510-845-8313
Mailing address:
  • Phone: 707-778-7862
  • Fax: 707-778-0969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberC33404
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: