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General NPI Number Information
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NPI Number | 1578792032
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Entity Type | Organization
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Legal Business Name | DR. MARY SOHA, M.D.,INC.
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Dates
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Enumeration Date | 07/06/2009
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Last Update Date | 07/06/2009
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Provider Practice Location Address
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Address Line | 4051 ATLANTIC BLVD
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City | JACKSONVILLE
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State | FL
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Zip | 32207-2036
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Country | US
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Telephone | 904-393-4700
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Fax | 904-493-9700
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Provider Business Mailing Address
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Address Line | 4051 ATLANTIC BLVD
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City | JACKSONVILLE
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State | FL
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Zip | 32207-2036
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Country | US
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Telephone | 904-393-4700
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Fax | 904-493-9700
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARY E SOHA
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Credential | M.D.
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Telephone | 904-393-4700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | ME56953
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License Number State | FL
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