Provider Demographics
NPI:1588740856
Name:SORENSEN, SONYA LILY (DO)
Entity type:Individual
Prefix:DR
First Name:SONYA
Middle Name:LILY
Last Name:SORENSEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MISS
Other - First Name:SONIA
Other - Middle Name:LILI
Other - Last Name:WOLFF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:502 WEST TENTH ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208
Mailing Address - Country:US
Mailing Address - Phone:214-948-9486
Mailing Address - Fax:972-283-0282
Practice Address - Street 1:502 WEST TENTH ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208
Practice Address - Country:US
Practice Address - Phone:214-948-9486
Practice Address - Fax:972-283-0282
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXGO151207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
00SF79Medicare ID - Type Unspecified
D97740Medicare UPIN