MEDICARE: BRIAN JAMES SORACE MD

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
1	2084N0400X	Neurology Physician	20910	NH
2	2084N0400X	Neurology Physician	89141	MT
3	2084N0400X	Neurology Physician	87250	GA
4	2084N0400X	Neurology Physician	A159642	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639565997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN JAMES SORACE MD

Provider Business Mailing Address
First Line	:	9110 COLLEGE POINTE CT
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33919-3244
Country	:	US
Telephone Number	:	239-208-2206
Fax Number	:

Provider Business Practice Location Address
First Line	:	9110 COLLEGE POINTE CT
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33919-3244
Country	:	US
Telephone Number	:	239-208-2206
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2015
Last Update Date	:	02/02/2022

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Directions to “ BRIAN JAMES SORACE MD” Practice Location

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