Healthcare Provider Details

I. General information

NPI: 1124282017
Provider Name (Legal Business Name): ROBERT SCOTT SOULIER DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2008
Last Update Date: 02/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 MORSE AVE
SACRAMENTO CA
95825-2115
US

IV. Provider business mailing address

1548 WOODGROVE WAY
ROSEVILLE CA
95661-4024
US

V. Phone/Fax

Practice location:
  • Phone: 916-973-6773
  • Fax:
Mailing address:
  • Phone: 801-815-7231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE4936
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: