Healthcare Provider Details

I. General information

NPI: 1245733492
Provider Name (Legal Business Name): SOMERS PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2018
Last Update Date: 03/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 W. LOOP 281, SUITE 474
LONGVIEW TX
75605
US

IV. Provider business mailing address

PO BOX 5699
LONGVIEW TX
75608
US

V. Phone/Fax

Practice location:
  • Phone: 903-230-3311
  • Fax: 903-230-3312
Mailing address:
  • Phone: 903-230-3311
  • Fax: 903-230-3312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberM9669
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License NumberM9669
License Number StateTX

VIII. Authorized Official

Name: CYNTHIA C. SOMERS
Title or Position: CEO
Credential: MD
Phone: 903-230-3311