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General NPI Number Information
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NPI Number | 1861929648
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Entity Type | Individual
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Provider Name | WILLEM SORGELOOS DPM
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Gender | Male
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Dates
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Enumeration Date | 05/11/2017
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Last Update Date | 10/19/2020
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Provider Practice Location Address
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Address Line | 34 FRANKLIN RD
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City | HATTIESBURG
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State | MS
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Zip | 39402-1318
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Country | US
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Telephone | 601-268-0400
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Fax |
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Provider Business Mailing Address
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Address Line | 155 CROSS CREEK PKWY APT 335
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City | HATTIESBURG
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State | MS
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Zip | 39402-4424
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Country | US
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Telephone | 423-367-8713
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 80235
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License Number State | MS
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