Individual
DR. JASON IAN SOFFA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
27450 SCHOENHERR RD, SUITE 400, WARREN, MI 48088-6683
(586) 582-7550
(586) 582-7515
Mailing address
27450 SCHOENHERR RD, SUITE 400, WARREN, MI 48088-6683
(586) 582-7550
(586) 582-7515
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
5101015353
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4828059
—
MI
05
—
5183594
—
MI
01
—
53150194353
CONTROLLED SUBSTANCE
MI
Enumeration date
02/27/2006
Last updated
08/17/2010
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