Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | B26552 | TX |
N | 207Q00000X | Family Doctor | G0145 | TX |
N | 207QG0300X | Family Doctor - Geriatric Medicine | B26552 | TX |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | G0145 | TX |
NPI | 1134126717 |
---|---|
Provider Name | Kathleen R Soch |
First Address | Irving, TX 75038-3813 |
Second Address | Corpus Christi, TX 78405-1804 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2005 |
Last Update Date | 08/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
102018204 | (05) | TX |
102018205 | (05) | TX |
1L5842 | MEDICARE (01) | TX |
B26552 | (02) | |
P02601817 | MCRR (01) | TX |