Provider Demographics
NPI:1427150903
Name:SORELLE, JONATHAN RICHARD (MD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:RICHARD
Last Name:SORELLE
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:PO BOX 160036
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32716-0036
Mailing Address - Country:US
Mailing Address - Phone:702-739-4263
Mailing Address - Fax:877-739-3590
Practice Address - Street 1:9080 W POST RD
Practice Address - Street 2:SUITE 200
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-2419
Practice Address - Country:US
Practice Address - Phone:702-739-4263
Practice Address - Fax:877-739-3590
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-04
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV12562207XS0106X
CT045195208600000X
OH57.006281208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1134418577Medicaid
NV1427150903Medicaid
NV1427150903Medicaid
NV1134418577Medicaid