Healthcare Provider Details

I. General information

NPI: 1871699801
Provider Name (Legal Business Name): SCOTT J SOIFER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 02/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 PARNASSUS AVE MOFFITT 680, BOX 0106
SAN FRANCISCO CA
94143-2204
US

IV. Provider business mailing address

478 LIVE OAK DR
MILL VALLEY CA
94941-3975
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-5153
  • Fax: 415-502-4186
Mailing address:
  • Phone: 415-381-5364
  • Fax: 415-502-4186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberG40405
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberG40405
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: