Provider Demographics
NPI:1063521896
Name:SORENSEN, ERIC N (MD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:N
Last Name:SORENSEN
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 1:1028 N DOUTY ST
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-3723
Mailing Address - Country:US
Mailing Address - Phone:559-589-6420
Mailing Address - Fax:
Practice Address - Street 1:1028 N DOUTY ST
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-3723
Practice Address - Country:US
Practice Address - Phone:559-589-6420
Practice Address - Fax:559-589-6425
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34991207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A449910OtherMEDI/CAL NUMBER
CA94-2728989OtherTAX ID NUMBER
CA00A449910OtherMEDI/CAL NUMBER
CA94-2728989OtherTAX ID NUMBER