1114971132 NPI number — DR. STEVEN B SOTMAN M.D.

Table of content: DR. STEVEN B SOTMAN M.D. (NPI 1114971132)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114971132 NPI number — DR. STEVEN B SOTMAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SOTMAN
Provider First Name:
STEVEN
Provider Middle Name:
B
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1114971132
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/06/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 34222
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT WORTH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76162-4222
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-295-4153
Provider Business Mailing Address Fax Number:
817-877-3493

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6100 HARRIS PKWY
Provider Second Line Business Practice Location Address:
SUITE 1210
Provider Business Practice Location Address City Name:
FORT WORTH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76132-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-295-4153
Provider Business Practice Location Address Fax Number:
817-877-3493
Provider Enumeration Date:
05/22/2006

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: 207RI0200X , with the licence number:  F5380 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 123422105 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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