Provider Demographics
NPI:1215065362
Name:SOPER, ROBERT E (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:E
Last Name:SOPER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 W ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-0834
Mailing Address - Country:US
Mailing Address - Phone:707-445-4705
Mailing Address - Fax:707-445-0581
Practice Address - Street 1:104 W ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-0834
Practice Address - Country:US
Practice Address - Phone:707-445-4705
Practice Address - Fax:707-445-0581
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG593802084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG59380OtherMEDICAL BOARD
CA9534922OtherMEDI-CAL
CABS8234940OtherDEA
CA9534922OtherMEDI-CAL
CA00G593800Medicare ID - Type Unspecified