Healthcare Provider Details

I. General information

NPI: 1558689984
Provider Name (Legal Business Name): KIMBERLY ANJA SOBELL DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KIMBERLY SOBELL HEUGELE DO

II. Dates (important events)

Enumeration Date: 05/10/2010
Last Update Date: 06/08/2022
Certification Date: 06/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 NE 8TH ST STE 300
GRESHAM OR
97030-7318
US

IV. Provider business mailing address

600 NE 8TH ST STE 301
GRESHAM OR
97030-7317
US

V. Phone/Fax

Practice location:
  • Phone: 503-988-5155
  • Fax: 503-988-5185
Mailing address:
  • Phone: 503-988-5155
  • Fax: 503-988-5185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number210173
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: