Healthcare Provider Details

I. General information

NPI: 1366773202
Provider Name (Legal Business Name): JEFFREY M SOARES PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2010
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 PRESIDENT AVE STE 307
FALL RIVER MA
02720-5928
US

IV. Provider business mailing address

1030 PRESIDENT AVE STE 307
FALL RIVER MA
02720-5928
US

V. Phone/Fax

Practice location:
  • Phone: 401-751-7546
  • Fax: 401-751-6888
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA3902
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: