Healthcare Provider Details

I. General information

NPI: 1295994358
Provider Name (Legal Business Name): DUSTIN S SORENSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2008
Last Update Date: 12/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N SIOUX POINT RD
DAKOTA DUNES SD
57049-5000
US

IV. Provider business mailing address

PO BOX 848
SIOUX FALLS SD
57101-0848
US

V. Phone/Fax

Practice location:
  • Phone: 605-232-3332
  • Fax:
Mailing address:
  • Phone: 605-339-6525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number8425
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number8425
License Number StateSD
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number5780
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: