1326145038 NPI number — BARRY J SOBEL MD

Table of content: BARRY J SOBEL MD (NPI 1326145038)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326145038 NPI number — BARRY J SOBEL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SOBEL
Provider First Name:
BARRY
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326145038
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/08/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2635 N 7TH ST
Provider Second Line Business Mailing Address:
SMG NEPHROLOGY
Provider Business Mailing Address City Name:
GRAND JUNCTION
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81501-8209
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-298-2273
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2635 NORTH 7TH. STREET
Provider Second Line Business Practice Location Address:
4 CENTER
Provider Business Practice Location Address City Name:
GRAND JUNCTION
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-298-7106
Provider Business Practice Location Address Fax Number:
970-298-7177
Provider Enumeration Date:
09/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X , with the licence number:  DR.0049789 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RN0300X , with the licence number: 38486 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 86981234 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 64063456 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000308960 . This is a "BCBS PROVIDER NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 38486 . This is a "LICENSE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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