Robert Eugene Soderblom, MD

Primary specialty

SpecialistTaxonomy code 174400000X

License

G12254 Issued in CA

Practice address

11201 Benton St
111N
Loma Linda, CA 92357-1000

Phone

(909) 825-7084

Fax

(909) 777-3858

NPI assigned

Sep 14, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1158192000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1386749067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34394 LA RAYE DR",
            "city": "YUCAIPA",
            "state": "CA",
            "postal_code": "923995023",
            "telephone_number": "909-835-7084",
            "fax_number": "909-777-3858"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11201 BENTON ST",
            "address_2": "111N",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923571000",
            "telephone_number": "909-825-7084",
            "fax_number": "909-777-3858"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SODERBLOM",
        "first_name": "ROBERT",
        "middle_name": "EUGENE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-14",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CA",
            "license": "G12254",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NARCOTIC",
            "identifier": "AS4562193",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "G12254",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Timothy Wyatt Smith, MD
• Jonathan William Smits, MD
• Eugene Peter Snissarenko, M.D.
• Alix Snodgrass
• Douglas Soderblom, O.D.
• Fred F Soeprono, M.D.
• Sindy Sohail, PA-C
• Andy Han-Byul Sohn, MD
• Roger D Sohn, DDS
• Daniil Alexandrovich Sokolov, MD

• Specialist in Loma Linda, CA
• Providers in Loma Linda, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.