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NPI Code Detail

MEDICARE: RUSSELL L. SORENSEN LLC

MEDICARE: RUSSELL L. SORENSEN LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialist1638911205UT

General Provider Information

NPI Number : 1568803773
Entity Type Code : Organization
Provider Name (Legal Business Name) : RUSSELL L. SORENSEN LLC
Provider Business Mailing Address
First Line : 9844 S 1300 E STE 250
Second Line :
City : SANDY
State : UT
Zip : 84094-4691
Country : US
Telephone Number : 801-571-1552
Fax Number : 801-571-1562
Provider Business Practice Location Address
First Line : 9844 S 1300 E STE 250
Second Line :
City : SANDY
State : UT
Zip : 84094-4691
Country : US
Telephone Number : 801-571-1552
Fax Number : 801-571-1562
Authorized Official
Title or Position : PRESIDENT
Name : RUSSELL L SORENSEN
Credential : M.D.
Telephone Number : 801-571-1552
Provider Enumeration Date : 07/16/2013
Last Update Date : 07/16/2013

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