Healthcare Provider Details

I. General information

NPI: 1669377552
Provider Name (Legal Business Name): SORESSA TAFERE JORE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2026
Last Update Date: 10/10/2026
Certification Date: 10/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

917 PACIFIC AVE STE 600
TACOMA WA
98402-4437
US

IV. Provider business mailing address

4883 BOATMAN LN
INVER GROVE HEIGHTS MN
55076-1160
US

V. Phone/Fax

Practice location:
  • Phone: 253-844-4327
  • Fax:
Mailing address:
  • Phone: 612-270-2214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberML70190394
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: