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General NPI Number Information
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NPI Number | 1669377552
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Entity Type | Individual
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Provider Name | SORESSA TAFERE JORE MD
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Gender | Male
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Dates
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Enumeration Date | 10/10/2026
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Last Update Date | 10/10/2026
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Provider Practice Location Address
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Address Line | 917 PACIFIC AVE STE 600
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City | TACOMA
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State | WA
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Zip | 98402-4437
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Country | US
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Telephone | 253-844-4327
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Fax |
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Provider Business Mailing Address
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Address Line | 4883 BOATMAN LN
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City | INVER GROVE HEIGHTS
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State | MN
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Zip | 55076-1160
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Country | US
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Telephone | 612-270-2214
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | ML70190394
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License Number State | WA
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