Healthcare Provider Details

I. General information

NPI: 1841463064
Provider Name (Legal Business Name): ERIC A. SODER, M.D.,P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2008
Last Update Date: 04/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2570 NW EDENBOWER BLVD SUITE 101
ROSEBURG OR
97470-6214
US

IV. Provider business mailing address

2570 NW EDENBOWER BLVD SUITE 101
ROSEBURG OR
97470-6214
US

V. Phone/Fax

Practice location:
  • Phone: 541-464-4177
  • Fax:
Mailing address:
  • Phone: 541-464-4177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD11890
License Number StateOR

VIII. Authorized Official

Name: ERIC A SODER
Title or Position: OWNER/PRESIDENT
Credential: M.D.
Phone: 541-464-4177