Healthcare Provider Details

I. General information

NPI: 1639195704
Provider Name (Legal Business Name): MATTHEW D SORENSEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 03/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 E HARMONY RD SUITE 170
FORT COLLINS CO
80528-3400
US

IV. Provider business mailing address

2121 E HARMONY RD SUITE 170
FORT COLLINS CO
80528-3400
US

V. Phone/Fax

Practice location:
  • Phone: 970-495-7421
  • Fax: 970-493-3528
Mailing address:
  • Phone: 970-495-7421
  • Fax: 970-493-3528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberDR.0045362
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: