Douglas Wayne Soderdahl, M.D.

Primary specialty

Urology PhysicianTaxonomy code 208800000X

License

34673-20 Issued in WI

Practice address

3851 Roger Brooke Drive
McHe-QD
Fort Sam Houston, TX 78234-6200

Phone

(210) 916-2460

NPI assigned

Dec 27, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1135641600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1431475200000",
    "number": "1245217769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3851 ROGER BROOKE DRIVE",
            "address_2": "MCHE-QD",
            "city": "FORT SAM HOUSTON",
            "state": "TX",
            "postal_code": "782346200",
            "telephone_number": "210-916-2460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3851 ROGER BROOKE DRIVE",
            "address_2": "MCHE-QD",
            "city": "FORT SAM HOUSTON",
            "state": "TX",
            "postal_code": "782346200",
            "telephone_number": "210-916-2460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SODERDAHL",
        "first_name": "DOUGLAS",
        "middle_name": "WAYNE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-27",
        "last_updated": "2015-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171000000X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider",
            "state": "VA",
            "license": "0101233888",
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "WI",
            "license": "34673-20",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Steven Snowden, PHD
• Patrick Larry Snyder, M.D.
• Michal Jan Sobieszczyk, MD
• Cheryl Lynn Soboleski, PHARMD
• Peter Joseph Sobraske
• Sheelah Dawn Sodhi, LCSW
• Adam Sokolowski, DNP
• Jeanie R Song, OTR
• Brian John Sonka, MD
• Sergio Eduardo Souza, M.D

• Urology Physician in Fort Sam Houston, TX
• Providers in Fort Sam Houston, TX by specialty
• Urology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.