Provider Demographics
NPI:1154406957
Name:SORG, DAVID ARTHUR (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:ARTHUR
Last Name:SORG
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 1:700 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46802-1402
Mailing Address - Country:US
Mailing Address - Phone:260-425-3560
Mailing Address - Fax:260-425-3568
Practice Address - Street 1:700 BROADWAY
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46802-1402
Practice Address - Country:US
Practice Address - Phone:260-425-3560
Practice Address - Fax:260-425-3568
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01019305207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100050680Medicaid
IN100050680Medicaid
IN150640GGGGMedicare PIN