Healthcare Provider Details
I. General information
NPI: 1548277494
Provider Name (Legal Business Name): RICHARD SORGEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 08/02/2006
Last Update Date: 11/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
516 E NIZHONI BLVD
GALLUP NM
87301-5748
US
IV. Provider business mailing address
6915 E CHAPARRAL RD
SCOTTSDALE AZ
85253-7032
US
V. Phone/Fax
- Phone: 505-722-1000
- Fax:
- Phone: 480-321-9943
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 2085R0202X |
| Taxonomy | Diagnostic Radiology Physician |
| License Number | 14635 |
| License Number State | AZ |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2085R0202X |
| Taxonomy | Diagnostic Radiology Physician |
| License Number | 10002 |
| License Number State | HI |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: