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NPI Code Detail

MEDICARE: RUSSELL LAMAR SORENSEN MD

MEDICARE: RUSSELL LAMAR SORENSEN 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
1207X00000XOrthopaedic Surgery Physician1638911205UT
2207XX0005XSports Medicine (Orthopaedic Surgery) Physician1638911205UT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11638911205OTHERUTSTATE LICENSE

General Provider Information

NPI Number : 1942202106
Entity Type Code : Individual
Provider Name (Legal Business Name) : RUSSELL LAMAR SORENSEN MD
Provider Business Mailing Address
First Line : 9844 S 1300 E
Second Line : STE 250
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
Second Line : STE 250
City : SANDY
State : UT
Zip : 84094-4691
Country : US
Telephone Number : 801-571-1552
Fax Number : 801-571-1562
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2005
Last Update Date : 09/11/2025

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