Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | C1-0008908 | DE |
NPI | 1013242668 |
---|---|
Provider Name | Dr. Ernest Soffronoff |
First Address | Lewes, DE 19958-5056 |
Second Address | Lewes, DE 19958-5056 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/10/2009 |
Last Update Date | 14/10/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C57565 | (02) | NJ |