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General NPI Number Information
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NPI Number | 1710927827
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Entity Type | Individual
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Provider Name | LISA M SORRELLS M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/07/2006
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Last Update Date | 05/26/2010
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Provider Practice Location Address
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Address Line | 206 2ND ST E
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City | BRADENTON
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State | FL
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Zip | 34208-1042
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Country | US
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Telephone | 941-955-4101
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Fax | 941-358-9817
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Provider Business Mailing Address
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Address Line | 8374 MARKET ST BOX 502
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City | LAKEWOOD RANCH
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State | FL
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Zip | 34202-5137
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Country | US
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Telephone | 941-955-4101
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Fax | 941-358-9817
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 5860777-1205
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | ME96808
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License Number State | FL
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