MEDICARE: EUGENE SOROKA MD INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	A92349	CA

General Provider Information

NPI Number	:	1841208881
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EUGENE SOROKA MD INC

Provider Business Mailing Address
First Line	:	246 E SCOTT ST
Second Line	:
City	:	PORT HUENEME
State	:	CA
Zip	:	93041
Country	:	US
Telephone Number	:	805-247-0708
Fax Number	:	805-271-0769

Provider Business Practice Location Address
First Line	:	246 E SCOTT ST
Second Line	:
City	:	PORT HUENEME
State	:	CA
Zip	:	93041-2918
Country	:	US
Telephone Number	:	805-271-0708
Fax Number	:	805-271-0769

Authorized Official
Title or Position	:	OWNER
Name	:	EUGENE SOROKA
Credential	:	MD
Telephone Number	:	805-247-0708

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	04/07/2011

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