Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | MD.24170 | AL |
NPI | 1063460343 |
---|---|
Provider Name | Dr. Jenny Oakes Sobera |
First Address | Manitowoc, WI 54220-4630 |
Second Address | Mountain Brk, AL 35223-1937 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2006 |
Last Update Date | 27/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I57685 | (02) | AL |