MEDICARE: JEFFREY M SORENSON 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	207T00000X	Neurological Surgery Physician	MD36662	TN

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	:	1760472757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY M SORENSON MD

Provider Business Mailing Address
First Line	:	6325 HUMPHREYS BLVD
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38120-2300
Country	:	US
Telephone Number	:	901-522-7700
Fax Number	:	901-522-2600

Provider Business Practice Location Address
First Line	:	1325 EASTMORELAND AVE
Second Line	:	STE 200
City	:	MEMPHIS
State	:	TN
Zip	:	38104-3519
Country	:	US
Telephone Number	:	901-259-5340
Fax Number	:	901-259-5300

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

Provider Enumeration Date	:	10/21/2005
Last Update Date	:	01/31/2013

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