Basic Information
| Provider Information | |||||||||
| NPI: | 1538249743 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KATHLEEN P SOE DO DERMATOLOGY PA | ||||||||
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| OtherOrganizationName: | VIRGINIA STREET DERMATOLOGY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 725 VIRGINIA ST | ||||||||
| Address2: | |||||||||
| City: | DUNEDIN | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346986615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7277344551 | ||||||||
| FaxNumber: | 7277368648 | ||||||||
| Practice Location | |||||||||
| Address1: | 725 VIRGINIA ST | ||||||||
| Address2: | |||||||||
| City: | DUNEDIN | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346986615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7277344551 | ||||||||
| FaxNumber: | 7277368648 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2006 | ||||||||
| LastUpdateDate: | 08/03/2009 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | SOE | ||||||||
| AuthorizedOfficialFirstName: | KATHLEEN | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | DOCTOR ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 7277344551 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | DO | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207NS0135X | OS8204 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Dermatology | Procedural Dermatology |
No ID Information.