Provider Demographics
NPI:1053420810
Name:ERIC N SORENSEN M.D. INC.
Entity type:Organization
Organization Name:ERIC N SORENSEN M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRED / CONTRACTING
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:G
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-303-8683
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34491207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ27826ZOtherMEDICARE ID