Active NPI
Gerald D Soderstrom, PH.D.
- Psychologist
- Wharton, TX
National Provider Identifier
1457504086
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 22059
- Practice address
- 1212 Briar LN
Wharton, TX 77488-4304 - Phone
- (979) 532-0900
- NPI assigned
- Oct 28, 2008
- Last updated
- Oct 28, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 22059 | TX | Primary |
| Counseling Psychologist | 103TC1900X | 22059 | TX |
Addresses
Primary practice location
1212 Briar LN
Wharton, TX 77488-4304
Mailing address
1212 Briar LN
Wharton, TX 77488-4304
Phone (979) 532-0900
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22059 | TX | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Deer Oaks Geriatric Services P C | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Deer Oaks Consultation Services
- Clinical Psychologist
- San Antonio, TX
- NPI 1134169287
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1225152000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1225152000000",
"number": "1457504086",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1212 BRIAR LN",
"city": "WHARTON",
"state": "TX",
"postal_code": "774884304",
"telephone_number": "979-532-0900"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1212 BRIAR LN",
"city": "WHARTON",
"state": "TX",
"postal_code": "774884304",
"telephone_number": "979-532-0900"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SODERSTROM",
"first_name": "GERALD",
"middle_name": "D",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-10-28",
"last_updated": "2008-10-28",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "TX",
"license": "22059",
"primary": true
},
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": "TX",
"license": "22059",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wharton, TX
- Stacey Silvas
- Simply RX LLC
- Skyline Healthcare Services, Inc.
- SMG Signature Medical Group (Gulf Coast Medical Associates)
- SMG Signature Medical Group (TGMA Wharton Rural Health Clinic)
- South Texas Medical Clinics, P.a.
- South Texas Medical Clinics, P.a. Dmerc
- South Texas Medical Clinics, P.a. Epsdt
- St. Christina's Medical Transportation LLC
- Stephen J Ringel MD PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.