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General NPI Number Information
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NPI Number | 1396038246
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Entity Type | Organization
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Legal Business Name | MICHAEL A. SORACE, MD MOHS MICROGRAPHIC & SKIN SURGERY, PLLC
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Dates
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Enumeration Date | 05/25/2011
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Last Update Date | 10/17/2011
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Provider Practice Location Address
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Address Line | 124 E BANDERA RD STE 406
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City | BOERNE
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State | TX
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Zip | 78006-2853
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Country | US
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Telephone | 830-331-9900
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Fax | 830-331-9908
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Provider Business Mailing Address
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Address Line | 124 E BANDERA RD STE 406
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City | BOERNE
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State | TX
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Zip | 78006-2853
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Country | US
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Telephone | 830-331-9900
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Fax | 830-331-9908
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Authorized Official
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Title or Position | PHYSICIAN
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Name | MICHAEL A. SORACE
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Credential | M.D.
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Telephone | 830-331-9900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | A99728
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License Number State | CA
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