Provider Demographics
NPI:1588774269
Name:SOBEL, ALTHEA C M (MD)
Entity type:Individual
Prefix:
First Name:ALTHEA
Middle Name:C M
Last Name:SOBEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CANDACE
Other - Middle Name:MOSELEY
Other - Last Name:SOBEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2115 STUART AVE
Mailing Address - Street 2:
Mailing Address - City:ALAMOSA
Mailing Address - State:CO
Mailing Address - Zip Code:81101-2269
Mailing Address - Country:US
Mailing Address - Phone:719-589-8005
Mailing Address - Fax:719-589-8023
Practice Address - Street 1:2115 STUART AVE
Practice Address - Street 2:
Practice Address - City:ALAMOSA
Practice Address - State:CO
Practice Address - Zip Code:81101-2269
Practice Address - Country:US
Practice Address - Phone:719-589-8005
Practice Address - Fax:719-589-8023
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO46825207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO840255530073OtherROCKY MOUNTAIN HEALTH PLANS
KS646100OtherFIRSTGUARD
MO25127035OtherBCBS KANSAS CITY
KS100320250AMedicaid
MO203800412Medicaid
CO29054788Medicaid
COCO300968Medicare PIN
CO29054788Medicaid
CO840255530073OtherROCKY MOUNTAIN HEALTH PLANS
KS370011472Medicare ID - Type UnspecifiedRAILROAD MEDICARE