MEDICARE: DR. GREGORY ROBERT SONN D.O.

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	OS9176	FL

General Provider Information

NPI Number	:	1326144254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGORY ROBERT SONN D.O.

Provider Business Mailing Address
First Line	:	2101 SW 23RD AVE
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33312-4517
Country	:	US
Telephone Number	:	954-551-4392
Fax Number	:	954-551-4392

Provider Business Practice Location Address
First Line	:	2101 SW 23RD AVE
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33312-4517
Country	:	US
Telephone Number	:	954-551-4392
Fax Number	:	954-551-4392

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2006
Last Update Date	:	07/09/2007

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