Healthcare Provider Details

I. General information

NPI: 1073937835
Provider Name (Legal Business Name): ROBERT SORENSEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2014
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 S WOODWORTH LOOP STE 101
PALMER AK
99645-7457
US

IV. Provider business mailing address

2250 S WOODWORTH LOOP STE 101
PALMER AK
99645-7457
US

V. Phone/Fax

Practice location:
  • Phone: 907-745-7546
  • Fax: 907-745-7540
Mailing address:
  • Phone: 907-745-7546
  • Fax: 907-745-7546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number233008
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number233008
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: