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General NPI Number Information
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NPI Number | 1134418577
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Entity Type | Organization
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Legal Business Name | JONATHAN R. SORELLE, MD., PLLC
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Dates
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Enumeration Date | 04/06/2011
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Last Update Date | 07/22/2024
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Provider Practice Location Address
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Address Line | 9080 W POST RD SUITE 200
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City | LAS VEGAS
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State | NV
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Zip | 89148-2419
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Country | US
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Telephone | 702-739-4263
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Fax | 877-739-3590
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Provider Business Mailing Address
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Address Line | PO BOX 160036
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City | ALTAMONTE SPRINGS
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State | FL
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Zip | 32716-0036
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Country | US
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Telephone | 702-739-4263
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Fax | 877-739-3590
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Authorized Official
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Title or Position | OWNER
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Name | JONATHAN SORELLE
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Credential | MD
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Telephone | 702-739-4263
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0106X
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Taxonomy Name | Orthopaedic Hand Surgery Physician
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License Number | 12562
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License Number State | NV
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