Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | DR.0062609 | CO |
NPI | 1003165671 |
---|---|
Provider Name | Dr. David Sorensen |
First Address | Fort Carson, CO 80913-4701 |
Second Address | Fort Carson, CO 80913-4701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2012 |
Last Update Date | 21/05/2020 |