Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 1641971205 | UT |
NPI | 1053502815 |
---|---|
Provider Name | Charles W Sorenson |
First Address | Slc, UT 84103-2885 |
Second Address | Slc, UT 84103-2885 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2007 |
Last Update Date | 07/08/2007 |