Provider Demographics
NPI:1538235718
Name:SOGOL, PAUL BARRY (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:BARRY
Last Name:SOGOL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:PAUL
Other - Middle Name:BARRY
Other - Last Name:SOGOL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:18840 VENTURA BLVD STE 207
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-3381
Mailing Address - Country:US
Mailing Address - Phone:818-776-2627
Mailing Address - Fax:818-776-9861
Practice Address - Street 1:18840 VENTURA BLVD STE 207
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-3381
Practice Address - Country:US
Practice Address - Phone:818-776-2627
Practice Address - Fax:818-776-9861
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00G39246207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEC000ZMedicare PIN
CAA47752Medicare UPIN