MEDICARE: GREGG S. SORENSEN, MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	G55173	CA

General Provider Information

NPI Number	:	1043494016
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREGG S. SORENSEN, MD

Provider Business Mailing Address
First Line	:	53 MANOR DR
Second Line	:	SUITE A
City	:	BAY POINT
State	:	CA
Zip	:	94565-6647
Country	:	US
Telephone Number	:	925-890-3356
Fax Number	:	925-945-1417

Provider Business Practice Location Address
First Line	:	53 MANOR DR
Second Line	:	SUITE A
City	:	BAY POINT
State	:	CA
Zip	:	94565-6647
Country	:	US
Telephone Number	:	925-458-6125
Fax Number	:	925-458-8513

Authorized Official
Title or Position	:	PHYSICIAN/OWNER
Name	:	GREGG SYNDER SORENSEN
Credential	:	M.D.
Telephone Number	:	925-890-3356

Provider Enumeration Date	:	12/26/2007
Last Update Date	:	12/26/2007

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