Provider Demographics
NPI:1063274611
Name:SORHUS, BRANDON JEREMY
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:JEREMY
Last Name:SORHUS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1006 KINGS RD APT C
Mailing Address - Street 2:
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501-2650
Mailing Address - Country:US
Mailing Address - Phone:406-564-5912
Mailing Address - Fax:
Practice Address - Street 1:1006 KINGS RD APT C
Practice Address - Street 2:
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501-2650
Practice Address - Country:US
Practice Address - Phone:406-564-5912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program