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General NPI Number Information
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NPI Number | 1245733492
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Entity Type | Organization
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Legal Business Name | SOMERS PEDIATRICS
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Dates
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Enumeration Date | 03/14/2018
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Last Update Date | 03/14/2018
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Provider Practice Location Address
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Address Line | 103 W. LOOP 281, SUITE 474
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City | LONGVIEW
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State | TX
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Zip | 75605
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Country | US
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Telephone | 903-230-3311
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Fax | 903-230-3312
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Provider Business Mailing Address
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Address Line | PO BOX 5699
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City | LONGVIEW
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State | TX
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Zip | 75608
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Country | US
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Telephone | 903-230-3311
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Fax | 903-230-3312
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Authorized Official
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Title or Position | CEO
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Name | CYNTHIA C. SOMERS
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Credential | MD
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Telephone | 903-230-3311
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0208X
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Taxonomy Name | Pediatric Infectious Diseases Physician
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License Number | M9669
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | M9669
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License Number State | TX
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